Provider Demographics
NPI:1063777696
Name:SHIELDS, MYAMARIA (MSW)
Entity type:Individual
Prefix:
First Name:MYAMARIA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:MYAMARIA
Other - Middle Name:
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3261 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2694
Mailing Address - Country:US
Mailing Address - Phone:352-686-3188
Mailing Address - Fax:352-686-9394
Practice Address - Street 1:3261 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2694
Practice Address - Country:US
Practice Address - Phone:352-686-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X
FLSW13554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical