Provider Demographics
NPI:1629109764
Name:SHIELDS, EMILY SIMOSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:SIMOSON
Last Name:SHIELDS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7664
Mailing Address - Country:US
Mailing Address - Phone:276-258-3733
Mailing Address - Fax:276-258-3734
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR
Practice Address - Street 2:SUITE 312
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-3733
Practice Address - Fax:276-258-3734
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-02-23
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Provider Licenses
StateLicense IDTaxonomies
VA01012481552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142570Medicaid
VAP00925988OtherRR MCARE
VA1629109764Medicaid
KY7100142570Medicaid