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General NPI Number Information
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NPI Number | 1427554377
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Entity Type | Individual
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Provider Name | MICHAEL CONNOR SHIELDS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2018
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 14 HUDSON AVE
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City | GLENS FALLS
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State | NY
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Zip | 12801-4448
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Country | US
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Telephone | 518-926-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LINDA LN
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City | NISKAYUNA
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State | NY
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Zip | 12309-1911
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 341135
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License Number State | NY
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