Healthcare Provider Details

I. General information

NPI: 1104330927
Provider Name (Legal Business Name): DANIEL SHIELDS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MUIR ST STE A
CAMBRIDGE MD
21613-1848
US

IV. Provider business mailing address

120 SPEER RD BLDG B
CHESTERTOWN MD
21620-1044
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-4045
  • Fax: 410-221-6457
Mailing address:
  • Phone: 410-778-9300
  • Fax: 410-778-9579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR202785
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR202785
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: