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General NPI Number Information
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NPI Number | 1760803456
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Entity Type | Individual
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Provider Name | MARY S. SHIELDS M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 402 TIDAL DRIVE
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City | LOVELADIES
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State | NJ
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Zip | 08008
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Country | US
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Telephone | 609-494-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 402 TIDAL DRIVE
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City | LOVELADIES
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State | NJ
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Zip | 08008
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Country | US
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Telephone | 609-494-1599
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 25MA05777900
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License Number State | NJ
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