Provider Demographics
NPI:1306693767
Name:MICHELE D. SHIELDES PLLC
Entity type:Organization
Organization Name:MICHELE D. SHIELDES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SHIELDES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC - SLP
Authorized Official - Phone:903-245-7720
Mailing Address - Street 1:401 E FRONT ST STE 123
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8250
Mailing Address - Country:US
Mailing Address - Phone:903-245-7720
Mailing Address - Fax:903-531-2451
Practice Address - Street 1:401 E FRONT ST STE 123
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8250
Practice Address - Country:US
Practice Address - Phone:903-245-7720
Practice Address - Fax:903-531-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty