Provider Demographics
NPI:1366926420
Name:SHIELDS, ANTHONY CEDRIC SR
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CEDRIC
Last Name:SHIELDS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WILKERSON AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2200
Mailing Address - Country:US
Mailing Address - Phone:866-481-5361
Mailing Address - Fax:
Practice Address - Street 1:170 WILKERSON AVE STE A&B
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2200
Practice Address - Country:US
Practice Address - Phone:866-481-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist