Provider Demographics
NPI:1427814672
Name:SHIELDS, PRESTON CHARLES
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:CHARLES
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E KINGSCREEK RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9535
Mailing Address - Country:US
Mailing Address - Phone:937-591-2655
Mailing Address - Fax:
Practice Address - Street 1:1243 E KINGSCREEK RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9535
Practice Address - Country:US
Practice Address - Phone:937-591-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child