Provider Demographics
NPI:1336779610
Name:SHIELD, JULIETTE EDWINA
Entity Type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:EDWINA
Last Name:SHIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WINDING WAY APT B
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5513
Mailing Address - Country:US
Mailing Address - Phone:813-802-0090
Mailing Address - Fax:
Practice Address - Street 1:127 WINDING WAY APT B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5513
Practice Address - Country:US
Practice Address - Phone:813-802-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0014206193376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide