=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801925797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA H SHIELDS LIC. AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE LANE CENTER 45 POND STREET
-----------------------------------------------------
City | NORWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-982-1616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 ROBESON ST APT. NO. 3
-----------------------------------------------------
City | JAMAICA PLAIN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02130-2941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-982-1616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 226459
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------