Provider Demographics
NPI:1295802759
Name:SHIEL, KATHLEEN ANGELA (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANGELA
Last Name:SHIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANGELA
Other - Last Name:BROSNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6801 LUCY CORR CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6657
Mailing Address - Country:US
Mailing Address - Phone:804-748-1227
Mailing Address - Fax:804-717-6659
Practice Address - Street 1:6801 LUCY CORR CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6657
Practice Address - Country:US
Practice Address - Phone:804-748-1227
Practice Address - Fax:804-717-6659
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010292192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945352Medicaid
262947467Medicare PIN