Healthcare Provider Details

I. General information

NPI: 1063777696
Provider Name (Legal Business Name): MYAMARIA SHIELDS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYAMARIA BOLDEN

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 COMMERCIAL WAY
SPRING HILL FL
34606-2694
US

IV. Provider business mailing address

3261 COMMERCIAL WAY
SPRING HILL FL
34606-2694
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-3188
  • Fax:
Mailing address:
  • Phone: 352-686-3188
  • Fax: 352-686-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW13554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: