Provider Demographics
NPI:1760884852
Name:SHIELDS, CHARMAINE A (NP)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:A
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHARMAINE
Other - Middle Name:A
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:198 E 121ST ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3523
Mailing Address - Country:US
Mailing Address - Phone:646-755-6461
Mailing Address - Fax:
Practice Address - Street 1:198 E 121ST ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3523
Practice Address - Country:US
Practice Address - Phone:646-755-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345764363LF0000X
DCRN1059196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily