MEDICARE: RYLEE NOEL 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	106H00000X	Marriage & Family Therapist	12857881-3902	UT

General Provider Information

NPI Number	:	1912490210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLEE NOEL SHIELDS

Provider Business Mailing Address
First Line	:	4626 N 300 W STE 150
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-6077
Country	:	US
Telephone Number	:	435-688-2123
Fax Number	:	801-877-0864

Provider Business Practice Location Address
First Line	:	393 E RIVERSIDE DR STE 3A
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-7127
Country	:	US
Telephone Number	:	435-688-2123
Fax Number	:	801-877-0864

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	01/24/2024

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Directions to “ RYLEE NOEL SHIELDS ” Practice Location

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