MEDICARE: SHIELDS AND ATRIUS HEALTH PET-CT AT DEDHAM LLC

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
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1053143487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELDS AND ATRIUS HEALTH PET-CT AT DEDHAM LLC

Provider Business Mailing Address
First Line	:	700 CONGRESS ST STE 204
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-0928
Country	:	US
Telephone Number	:	866-258-4738
Fax Number	:	888-662-4700

Provider Business Practice Location Address
First Line	:	40 ALLIED DR STE 112-A
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-6146
Country	:	US
Telephone Number	:	866-258-4738
Fax Number	:	888-662-4700

Authorized Official
Title or Position	:	CFO
Name	:	KRISTEN DELMORE
Credential	:
Telephone Number	:	617-376-7400

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	03/19/2026

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