MEDICARE: MICHAEL CONNOR SHIELDS

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	208600000X	Surgery Physician	341135	NY

General Provider Information

NPI Number	:	1427554377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CONNOR SHIELDS

Provider Business Mailing Address
First Line	:	5 LINDA LN
Second Line	:
City	:	NISKAYUNA
State	:	NY
Zip	:	12309-1911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 HUDSON AVE
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4448
Country	:	US
Telephone Number	:	518-926-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2018
Last Update Date	:	03/09/2026

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