Provider Demographics
NPI:1013088921
Name:SHIELDS, ANDREW JACKSON
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JACKSON
Last Name:SHIELDS
Suffix:
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:BUILDING N46 CAPE SARICHEF
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AZ
Mailing Address - Zip Code:99619
Mailing Address - Country:US
Mailing Address - Phone:907-487-5757
Mailing Address - Fax:907-487-5360
Practice Address - Street 1:BUILDING N46 CAPE SARICHEF
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AZ
Practice Address - Zip Code:99619
Practice Address - Country:US
Practice Address - Phone:907-487-5757
Practice Address - Fax:907-487-5360
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other