MEDICARE: DANIEL L O'SHIELDS PH.D

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	101YP2500X	Professional Counselor	1415	SC

General Provider Information

NPI Number	:	1710980008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL L O'SHIELDS PH.D

Provider Business Mailing Address
First Line	:	323 W SOUTH ST
Second Line	:
City	:	UNION
State	:	SC
Zip	:	29379-2838
Country	:	US
Telephone Number	:	864-427-1601
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 W SOUTH ST
Second Line	:
City	:	UNION
State	:	SC
Zip	:	29379-2838
Country	:	US
Telephone Number	:	864-427-1601
Fax Number	:	864-427-1605

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/28/2007

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