Provider Demographics
NPI:1962114793
Name:SHIELDS, ARALYNN FAITH (LMT, EMT-P)
Entity type:Individual
Prefix:MS
First Name:ARALYNN
Middle Name:FAITH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LMT, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17039 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DOSWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23047-1618
Mailing Address - Country:US
Mailing Address - Phone:512-576-2134
Mailing Address - Fax:
Practice Address - Street 1:17039 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DOSWELL
Practice Address - State:VA
Practice Address - Zip Code:23047-1618
Practice Address - Country:US
Practice Address - Phone:512-576-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist