MEDICARE: SHIELDS & FIDANZA, LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1689724999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELDS & FIDANZA, LLC

Provider Business Mailing Address
First Line	:	8141 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4682
Country	:	US
Telephone Number	:	502-423-7222
Fax Number	:	502-423-7277

Provider Business Practice Location Address
First Line	:	8141 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4682
Country	:	US
Telephone Number	:	502-423-7222
Fax Number	:	502-423-7277

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DAWN MARIE DENNA
Credential	:
Telephone Number	:	502-423-7222

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/22/2020

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