MEDICARE: MATILDA H SHIELDS DPH

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	183500000X	Pharmacist	8158	TN
2	183500000X	Pharmacist	E-8285	MS

General Provider Information

NPI Number	:	1972880359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATILDA H SHIELDS DPH

Provider Business Mailing Address
First Line	:	5136 MORNINGWOOD LN
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-4878
Country	:	US
Telephone Number	:	615-941-4196
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 DONELSON PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3729
Country	:	US
Telephone Number	:	615-883-5108
Fax Number	:

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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Directions to “ MATILDA H SHIELDS DPH” Practice Location

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