Provider Demographics
NPI:1427018506
Name:SHIELDS, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3353
Mailing Address - Country:US
Mailing Address - Phone:727-466-6564
Mailing Address - Fax:727-466-9434
Practice Address - Street 1:1211 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3353
Practice Address - Country:US
Practice Address - Phone:727-466-6564
Practice Address - Fax:727-466-9434
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME053720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAO434OtherMEDICARE PTAN
FL049420800Medicaid
FLC29843Medicare UPIN
FL049420800Medicaid