MEDICARE: JESSICA 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	207T00000X	Neurological Surgery Physician	88776	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207T00000X	Neurological Surgery Physician	181435	CA

General Provider Information

NPI Number	:	1679960140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SHIELDS

Provider Business Mailing Address
First Line	:	1180 N PALM CANYON DR STE E205
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4402
Country	:	US
Telephone Number	:	760-325-1202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 N PALM CANYON DR # E205
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4402
Country	:	US
Telephone Number	:	760-325-1202
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	02/03/2023

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Directions to “ JESSICA SHIELDS ” Practice Location

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