Individual
FREDERICK SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(718) 470-3768
Mailing address
24228 130TH RD, ROSEDALE, NY 11422-1143
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403085
NY
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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