Provider Demographics
NPI:1922350115
Name:SHIELDS PODIATRY LLC
Entity Type:Organization
Organization Name:SHIELDS PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:571-315-8842
Mailing Address - Street 1:705 MOBJACK PL
Mailing Address - Street 2:STE B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1966
Mailing Address - Country:US
Mailing Address - Phone:757-873-2101
Mailing Address - Fax:757-873-2118
Practice Address - Street 1:705 MOBJACK PL
Practice Address - Street 2:STE B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1966
Practice Address - Country:US
Practice Address - Phone:757-873-2101
Practice Address - Fax:757-873-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty