Provider Demographics
NPI:1699192849
Name:SHIELDS, ASHLEY HAMPTON (PHD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HAMPTON
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:SIERRA
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:22 NORTHEAST DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2732
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-6250
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006293103TC0700X
PAPS019991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1699192849Medicaid
WIK400331136Medicare PIN