Provider Demographics
NPI:1801936406
Name:SHIELDS, JOHN MENDELL (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MENDELL
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MONTGOMERY ST
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-2902
Mailing Address - Country:US
Mailing Address - Phone:415-434-4037
Mailing Address - Fax:
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2191
Practice Address - Country:US
Practice Address - Phone:415-706-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22988103TF0200X
CAPSY 13804103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic