MEDICARE: MRS. SHERI MICHELE SHIELS RPAC

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	363A00000X	Physician Assistant	007393	NY

General Provider Information

NPI Number	:	1588650071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERI MICHELE SHIELS RPAC

Provider Business Mailing Address
First Line	:	243 BOYLE RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-1954
Country	:	US
Telephone Number	:	631-696-2000
Fax Number	:	631-696-2003

Provider Business Practice Location Address
First Line	:	243 BOYLE RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-1954
Country	:	US
Telephone Number	:	631-696-2000
Fax Number	:	631-696-2003

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/08/2007

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