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General NPI Number Information
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NPI Number | 1942247127
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Entity Type | Organization
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Legal Business Name | SHIELDS & FIDANZA, LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CHAMPION FARMS DRIVE
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City | LOUISVILLE
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State | KY
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Zip | 40241
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Country | US
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Telephone | 502-345-8544
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Fax |
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Provider Business Mailing Address
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Address Line | 3211 CROSSHILL CT
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City | PROSPECT
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State | KY
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Zip | 40059-8174
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Country | US
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Telephone | 502-345-8544
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Fax |
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Authorized Official
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Title or Position | OWNER/CONTRACTOR
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Name | MRS. MICHELLE FIDANZA
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Credential |
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Telephone | 502-345-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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