Healthcare Provider Details

I. General information

NPI: 1063501526
Provider Name (Legal Business Name): SHIELDS AND SHIELDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT STREET SUITE 1440
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

840 WALNUT STREET SUITE 1440
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-928-3105
  • Fax: 215-928-1140
Mailing address:
  • Phone: 215-928-3105
  • Fax: 215-928-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY A SHIELDS
Title or Position: DIRECTOR
Credential: MD
Phone: 215-928-3105