Provider Demographics
NPI:1689626327
Name:SHIELDS, MICHAEL WALKER (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALKER
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SHAWME RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2309
Mailing Address - Country:US
Mailing Address - Phone:508-833-8202
Mailing Address - Fax:
Practice Address - Street 1:1645 FALMOUTH RD
Practice Address - Street 2:BAYBERRY SQUARE UNIT E-3
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2932
Practice Address - Country:US
Practice Address - Phone:508-353-8359
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical