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Individual

GARY EDWARD SHIELDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
614 COOPER HILL RD, WYNANTSKILL, NY 12198-2906
(518) 283-6500
(518) 283-0524
Mailing address
614 COOPER HILL RD, WYNANTSKILL, NY 12198-2906

Taxonomy

Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
499610
NY

Other

Enumeration date
01/08/2019
Last updated
01/08/2019
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