MEDICARE: SUSAN M SHIELDS PA-C

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	363A00000X	Physician Assistant	PA1037	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	V77796	OTHER	NV	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1538244512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M SHIELDS PA-C

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	702-344-2936
Fax Number	:	877-707-4582

Provider Business Practice Location Address
First Line	:	2381 E WINDMILL LN STE 14
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2069
Country	:	US
Telephone Number	:	725-258-2980
Fax Number	:	877-707-4582

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	02/13/2026

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Directions to “ SUSAN M SHIELDS PA-C” Practice Location

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