Basic Information
| Provider Information | |||||||||
| NPI: | 1518510940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELDING | ||||||||
| FirstName: | SHANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032223021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022770122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 VALLEY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070422321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014904333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.