Provider Demographics
NPI:1538244512
Name:SHIELDS, SUSAN M (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:702-344-2936
Mailing Address - Fax:877-707-4582
Practice Address - Street 1:2381 E WINDMILL LN STE 14
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2069
Practice Address - Country:US
Practice Address - Phone:725-258-2980
Practice Address - Fax:877-707-4582
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538244512Medicaid
NVV77796OtherMEDICARE
NV100505667Medicaid
NV33676Medicare PIN