Healthcare Provider Details

I. General information

NPI: 1841642725
Provider Name (Legal Business Name): JOYCE DAQNAL SHIELDS PMHCNS-BC CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OAKLEY RD
BELMONT MA
02478-2734
US

IV. Provider business mailing address

132 OAKLEY RD
BELMONT MA
02478-2734
US

V. Phone/Fax

Practice location:
  • Phone: 617-645-4959
  • Fax:
Mailing address:
  • Phone: 617-645-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN121047
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: