Provider Demographics
NPI:1124151063
Name:SHIELDS, JEFFREY DONALD (ATC,MED)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DONALD
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:ATC,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-5608
Mailing Address - Country:US
Mailing Address - Phone:717-939-1153
Mailing Address - Fax:
Practice Address - Street 1:75 EVELYN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1258
Practice Address - Country:US
Practice Address - Phone:717-692-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000334A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer