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NPI Code Detail

MEDICARE: BETHANY SHIELDS NP

MEDICARE: BETHANY SHIELDS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5015736NC

General Provider Information

NPI Number : 1134873466
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY SHIELDS NP
Provider Business Mailing Address
First Line : 909 RIDGEBROOK RD STE 300
Second Line :
City : SPARKS
State : MD
Zip : 21152-9477
Country : US
Telephone Number : 443-383-9300
Fax Number :
Provider Business Practice Location Address
First Line : 6047 TYVOLA GLEN CIR STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28217-6431
Country : US
Telephone Number : 443-383-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2022
Last Update Date : 02/26/2026

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