1992534374 NPI number — SARAH SHEILDS

Table of content: SARAH SHEILDS (NPI 1992534374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992534374 NPI number — SARAH SHEILDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEILDS
Provider First Name:
SARAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992534374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADDON HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08035-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-816-8801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 NJ-168 N
Provider Second Line Business Practice Location Address:
UNIT G3
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-302-5728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC06348100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)