MEDICARE: DR. JUDITH I SHIELDS PHD

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
1	103T00000X	Psychologist	5276	OH

General Provider Information

NPI Number	:	1265507867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH I SHIELDS PHD

Provider Business Mailing Address
First Line	:	PO BOX 21753
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121
Country	:	US
Telephone Number	:	216-262-6206
Fax Number	:

Provider Business Practice Location Address
First Line	:	2469 FAIRMOUNT BLVD
Second Line	:	STE. 320
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44106
Country	:	US
Telephone Number	:	216-262-6206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	01/07/2015

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Directions to “ DR. JUDITH I SHIELDS PHD” Practice Location

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