Provider Demographics
NPI:1588681134
Name:SHIELDS, SONDRA ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:ESTHER
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4703
Mailing Address - Country:US
Mailing Address - Phone:813-961-8436
Mailing Address - Fax:813-961-4422
Practice Address - Street 1:6640 78TH AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2064
Practice Address - Country:US
Practice Address - Phone:727-518-8660
Practice Address - Fax:727-518-8662
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62444207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255309100Medicaid
FLE1664Medicare ID - Type Unspecified
FL255309100Medicaid