Individual
MICHAEL S DESHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 NEW YORK AVE, TRENTON, NJ 08638-3913
(609) 393-8000
Mailing address
20 N WOODBURY TURNERSVILLE RD, BLACKWOOD, NJ 08012-2888
(856) 374-6740
(856) 374-6520
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
25MA04362400
NJ
251K00000X
Public Health or Welfare Agency
25MA04362400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3193608
—
NJ
Enumeration date
08/21/2006
Last updated
07/03/2019
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