Healthcare Provider Details

I. General information

NPI: 1447240262
Provider Name (Legal Business Name): DANIEL A SHIELDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 11TH ST
CARROLLTON KY
41008-1435
US

IV. Provider business mailing address

PO BOX 511
DRY RIDGE KY
41035-0511
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-4321
  • Fax:
Mailing address:
  • Phone: 859-824-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25514
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25514
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: