MEDICARE: ANGELA 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	163WC0400X	Case Management Registered Nurse	31123601	PA
2	163WC2100X	Continence Care Registered Nurse	31123601	PA
3	253Z00000X	In Home Supportive Care Agency	31123601	PA
4	372500000X	Chore Provider	31123601	PA
5	372600000X	Adult Companion	31123601	PA
6	3747A0650X	Attendant Care Provider	31123601	PA
7	374U00000X	Home Health Aide	31123601	PA
8	376J00000X	Homemaker	31123601	PA
9	376K00000X	Nurse's Aide	31123601	PA
10	3747P1801X	Personal Care Attendant	31123601	PA

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	:	1649729039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SHIELDS

Provider Business Mailing Address
First Line	:	5826 PENTRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4532
Country	:	US
Telephone Number	:	484-561-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	5826 PENTRIDGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4532
Country	:	US
Telephone Number	:	267-241-1411
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	02/28/2022

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Directions to “ ANGELA SHIELDS ” Practice Location

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