Healthcare Provider Details

I. General information

NPI: 1538818711
Provider Name (Legal Business Name): CHRISTOPHER SHIELDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-487-8340
  • Fax: 843-692-1122
Mailing address:
  • Phone: 843-487-8340
  • Fax: 843-692-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number76444
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: