Provider Demographics
NPI:1902109663
Name:SHIELDS, ROBIN ELAINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ROBIN
Middle Name:ELAINE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 GLEASON CIR
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2350
Mailing Address - Country:US
Mailing Address - Phone:585-309-3604
Mailing Address - Fax:
Practice Address - Street 1:722 GLEASON CIR
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2350
Practice Address - Country:US
Practice Address - Phone:585-309-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302996-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse