Healthcare Provider Details

I. General information

NPI: 1497297824
Provider Name (Legal Business Name): SHELLY ANN SHIELDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 AIRPORT PKWY STE 114
GREENWOOD IN
46143-1439
US

IV. Provider business mailing address

65 AIRPORT PKWY STE 114
GREENWOOD IN
46143-1439
US

V. Phone/Fax

Practice location:
  • Phone: 317-807-0268
  • Fax: 317-851-8930
Mailing address:
  • Phone: 317-807-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71006814A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28153968A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: