Provider Demographics
NPI:1588688329
Name:SHIELDS, ANDREA L (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9045 HAVEN AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5427
Mailing Address - Country:US
Mailing Address - Phone:909-980-7736
Mailing Address - Fax:909-980-8308
Practice Address - Street 1:9045 HAVEN AVE
Practice Address - Street 2:STE 107
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5427
Practice Address - Country:US
Practice Address - Phone:909-980-7736
Practice Address - Fax:909-980-8308
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6209103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical