Healthcare Provider Details

I. General information

NPI: 1346037447
Provider Name (Legal Business Name): EMILY SHIELDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 EXECUTIVE DR
NEWARK DE
19702-3357
US

IV. Provider business mailing address

1088 GREENTREE RD
BLUE BELL PA
19422-1511
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-2888
  • Fax:
Mailing address:
  • Phone: 215-375-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066375
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012222
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: