Healthcare Provider Details

I. General information

NPI: 1730709965
Provider Name (Legal Business Name): PATRICK SHIELDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 HARVEST DR STE 140
BLUE BELL PA
19422-1955
US

IV. Provider business mailing address

980 HARVEST DR STE 140
BLUE BELL PA
19422-1955
US

V. Phone/Fax

Practice location:
  • Phone: 610-699-8800
  • Fax: 267-316-5411
Mailing address:
  • Phone: 610-699-8800
  • Fax: 267-316-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD484392
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: