Provider Demographics
NPI:1801925797
Name:SHIELDS, MONICA H (LIC AC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:H
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ROBESON ST
Mailing Address - Street 2:APT. NO. 3
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2941
Mailing Address - Country:US
Mailing Address - Phone:781-982-1616
Mailing Address - Fax:
Practice Address - Street 1:THE LANE CENTER
Practice Address - Street 2:45 POND STREET
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-982-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist