Provider Demographics
NPI:1427333699
Name:SHIELDS, HEATHER (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:VOBORSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:4444 GEARY BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3048
Mailing Address - Country:US
Mailing Address - Phone:415-683-5622
Mailing Address - Fax:
Practice Address - Street 1:4444 GEARY BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3048
Practice Address - Country:US
Practice Address - Phone:415-683-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist