Provider Demographics
NPI:1275352791
Name:SHIELDS, CHRISTINA ANNE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANNE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 HUGHES SHOP RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-2911
Mailing Address - Country:US
Mailing Address - Phone:443-974-1443
Mailing Address - Fax:
Practice Address - Street 1:1320 HUGHES SHOP RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-2911
Practice Address - Country:US
Practice Address - Phone:443-974-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4607174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN