Provider Demographics
NPI:1962066282
Name:SHIELDS, JOHN (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 DELANCEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-3308
Mailing Address - Country:US
Mailing Address - Phone:212-233-3233
Mailing Address - Fax:212-233-2034
Practice Address - Street 1:150 DELANCEY ST STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3308
Practice Address - Country:US
Practice Address - Phone:212-233-3233
Practice Address - Fax:212-233-2034
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007261213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery