Healthcare Provider Details

I. General information

NPI: 1649258948
Provider Name (Legal Business Name): ANDREA DENISE SHIELDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA DENISE FISK M.D.

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8085
US

IV. Provider business mailing address

263 FARMINGTON AVENUE
FARMINGTON CT
06030-8085
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2792
  • Fax: 860-679-1494
Mailing address:
  • Phone: 860-679-2792
  • Fax: 860-679-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number067414
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: