Shields, Mary Ellen Theresa
Shields, Mary Ellen Theresa is an sole proprietor health care provider with primary practice located at 305 Estill St , Berea KY 40403-1742. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Shields, Mary Ellen Theresa can be contacted via phone (859) 986-8418.Contact Information
Primary practice address
305 Estill St
Berea KY 40403-1742
Phone: (859) 986-8418
Fax: (859) 986-6568
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 30354 | Kentucky |
Profile Details
| NPI number | 1285680553 |
|---|---|
| LBN Legal business name | Shields, Mary Ellen Theresa |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 26th, 2006 |
| Last updated | May 5th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285680553 | NPPES |
| Kentucky | MEDICAID | 64303548 | |
| Kentucky | Other | P00357584 |
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