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NPI Code Detail

MEDICARE: DARRAH RENEE SHIELDS MD

MEDICARE: DARRAH RENEE SHIELDS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics PhysicianME150685FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013412196
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRAH RENEE SHIELDS MD
Provider Business Mailing Address
First Line : 510 VENETIAN VILLA DR
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-5348
Country : US
Telephone Number : 904-716-1574
Fax Number :
Provider Business Practice Location Address
First Line : 596 COURTLAND BLVD
Second Line :
City : DELTONA
State : FL
Zip : 32738-8902
Country : US
Telephone Number : 407-249-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2018
Last Update Date : 06/29/2021

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