Provider Demographics
NPI:1295124733
Name:SHIELDS, BRANDI NICOLE (SA-C, CST)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:NICOLE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:SA-C, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 E PALM LN
Mailing Address - Street 2:#120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-2716
Mailing Address - Country:US
Mailing Address - Phone:602-334-3216
Mailing Address - Fax:
Practice Address - Street 1:7001 E PALM LN
Practice Address - Street 2:#120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2716
Practice Address - Country:US
Practice Address - Phone:602-334-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14-440246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant