Provider Demographics
NPI:1649258948
Name:SHIELDS, ANDREA DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DENISE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:DENISE
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8085
Mailing Address - Country:US
Mailing Address - Phone:860-679-2792
Mailing Address - Fax:860-679-1494
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8085
Practice Address - Country:US
Practice Address - Phone:860-679-2792
Practice Address - Fax:860-679-1494
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT067414207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LP484OtherBCBS
TX366805503Medicaid