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General NPI Number Information
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NPI Number | 1417537192
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Entity Type | Individual
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Provider Name | MICHELLE SHIELDS LMT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 2014 WASHINGTON ST
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City | NEWTON
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State | MA
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Zip | 02462-1607
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Country | US
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Telephone | 617-831-7430
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Fax | 617-219-1243
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Provider Business Mailing Address
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Address Line | 11 WHITE RD
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City | WAYLAND
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State | MA
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Zip | 01778-2416
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Country | US
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Telephone | 508-358-0858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10429
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License Number State | MA
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