Provider Demographics
NPI:1841805199
Name:SHIELDS, CHRISTOPHER P JR
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:SHIELDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5954
Mailing Address - Country:US
Mailing Address - Phone:198-566-2379
Mailing Address - Fax:985-662-3829
Practice Address - Street 1:1102 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5954
Practice Address - Country:US
Practice Address - Phone:198-566-2379
Practice Address - Fax:985-662-3829
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator