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General NPI Number Information
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NPI Number | 1619786381
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Entity Type | Individual
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Provider Name | TERRY OBRIEN SHIELDS
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Gender | Male
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 3502 HENDERSON BLVD UNIT 335
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City | TAMPA
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State | FL
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Zip | 33609-3970
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Country | US
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Telephone | 404-838-0607
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Fax |
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Provider Business Mailing Address
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Address Line | 6819 INTERBAY BLVD APT 6
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City | TAMPA
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State | FL
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Zip | 33616-2646
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Country | US
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Telephone | 404-838-6007
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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