Provider Demographics
NPI:1871599076
Name:SHIELDS, HEATHER M (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:740-633-1100
Mailing Address - Fax:
Practice Address - Street 1:92 N 4TH ST STE 26
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1600
Practice Address - Country:US
Practice Address - Phone:740-633-4360
Practice Address - Fax:740-633-4361
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV209363A00000X
OH50.002602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPA23591Medicare ID - Type Unspecified