Provider Demographics
NPI:1386609550
Name:SHIELDS, PAMELA JEANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEANNE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-9205
Mailing Address - Country:US
Mailing Address - Phone:610-653-0353
Mailing Address - Fax:
Practice Address - Street 1:216 N 4TH ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2718
Practice Address - Country:US
Practice Address - Phone:610-653-0353
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009302L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASH1725443OtherHIGHMARK BLUE SHIELD
PACP 076066Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST