Provider Demographics
NPI:1376439810
Name:SHIELDS, TORI BROOKE
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:BROOKE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 1/2 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-4635
Mailing Address - Country:US
Mailing Address - Phone:918-843-6709
Mailing Address - Fax:
Practice Address - Street 1:504 1/2 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-4635
Practice Address - Country:US
Practice Address - Phone:918-843-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty