Basic Information
| Provider Information | |||||||||
| NPI: | 1588681134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIELDS | ||||||||
| FirstName: | SONDRA | ||||||||
| MiddleName: | ESTHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3619 BERGER RD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335484703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139618436 | ||||||||
| FaxNumber: | 8139614422 | ||||||||
| Practice Location | |||||||||
| Address1: | 6640 78TH AVE N | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337812064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275188660 | ||||||||
| FaxNumber: | 7275188662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME62444 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 255309100 | 05 | FL | MEDICAID |