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NPI Code Detail

MEDICARE: DR. STEPHEN WYATT SHIELD M.D.

MEDICARE: DR. STEPHEN WYATT SHIELD M.D.
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
1207K00000XAllergy & Immunology Physician0101049643VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
200Y225A01OTHERVAMEDICARE PTAN

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 : 1073590071
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN WYATT SHIELD M.D.
Provider Business Mailing Address
First Line : PO BOX 603725
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-3725
Country : US
Telephone Number : 828-575-2625
Fax Number : 828-350-2174
Provider Business Practice Location Address
First Line : 1144 PROFESSIONAL DR
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23185-3330
Country : US
Telephone Number : 757-259-0443
Fax Number : 757-259-0450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 11/01/2023

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