Healthcare Provider Details

I. General information

NPI: 1649729039
Provider Name (Legal Business Name): ANGELA SHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 02/28/2022
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 PENTRIDGE ST
PHILADELPHIA PA
19143-4532
US

IV. Provider business mailing address

5826 PENTRIDGE ST
PHILADELPHIA PA
19143-4532
US

V. Phone/Fax

Practice location:
  • Phone: 267-241-1411
  • Fax:
Mailing address:
  • Phone: 484-561-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number31123601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number31123601
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number31123601
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number31123601
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number31123601
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number31123601
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number31123601
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number31123601
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number31123601
License Number StatePA
# 10
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number31123601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: