Provider Demographics
NPI:1396114146
Name:FIELDS, SHAYLYNN
Entity type:Individual
Prefix:
First Name:SHAYLYNN
Middle Name:
Last Name:FIELDS
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 1:1305 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4225
Mailing Address - Country:US
Mailing Address - Phone:217-679-7937
Mailing Address - Fax:217-679-5923
Practice Address - Street 1:1305 STEVENSON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4225
Practice Address - Country:US
Practice Address - Phone:217-679-7937
Practice Address - Fax:217-679-5923
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver