Provider Demographics
NPI:1265972350
Name:SHIELDS, KEITH D'ALTON (PA-C)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:D'ALTON
Last Name:SHIELDS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:174 ARMISTICE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3269
Mailing Address - Country:US
Mailing Address - Phone:401-753-0500
Mailing Address - Fax:401-475-1400
Practice Address - Street 1:2 WAKE ROBIN RD UNIT 103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4241
Practice Address - Country:US
Practice Address - Phone:013-341-1444
Practice Address - Fax:401-334-1144
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2021-10-21
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant