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
Fax: (859) 986-6568
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285680553 NPPES
Kentucky MEDICAID 64303548
Kentucky Other P00357584

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