Healthcare Provider Details

I. General information

NPI: 1053143487
Provider Name (Legal Business Name): SHIELDS AND ATRIUS HEALTH PET-CT AT DEDHAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ALLIED DR STE 112-A
DEDHAM MA
02026-6146
US

IV. Provider business mailing address

700 CONGRESS ST STE 204
QUINCY MA
02169-0928
US

V. Phone/Fax

Practice location:
  • Phone: 866-258-4738
  • Fax: 888-662-4700
Mailing address:
  • Phone: 866-258-4738
  • Fax: 888-662-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN DELMORE
Title or Position: CFO
Credential:
Phone: 617-376-7400