Provider Demographics
NPI:1811245772
Name:SHIELDS, DELITA DANYELLE (IDC)
Entity type:Individual
Prefix:MRS
First Name:DELITA
Middle Name:DANYELLE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ST SE
Mailing Address - Street 2:BUILDING: 175
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374-5162
Mailing Address - Country:US
Mailing Address - Phone:910-545-9284
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE
Practice Address - Street 2:BUILDING: 175
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:910-545-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman