Provider Demographics
NPI:1629629944
Name:SHIELDS, FREEMAN (LLP)
Entity Type:Individual
Prefix:MR
First Name:FREEMAN
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28470 EASTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4253
Mailing Address - Country:US
Mailing Address - Phone:248-840-3087
Mailing Address - Fax:
Practice Address - Street 1:5728 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2298
Practice Address - Country:US
Practice Address - Phone:313-354-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007754103TC0700X
MI6362008501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical