Provider Demographics
NPI:1790336618
Name:SHIELDS, REGINA (AUTHORIZED OFFICER)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:AUTHORIZED OFFICER
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHIEF EXECUTIVE
Mailing Address - Street 1:PO BOX 11034
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-0034
Mailing Address - Country:US
Mailing Address - Phone:513-309-3330
Mailing Address - Fax:
Practice Address - Street 1:2850 LAFEUILLE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7619
Practice Address - Country:US
Practice Address - Phone:513-638-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374700000XNursing Service Related ProvidersTechnician
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide