Provider Demographics
NPI:1669267886
Name:SHIELDS, SHANNON SCOTT (NBC-HWC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SCOTT
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3543
Mailing Address - Country:US
Mailing Address - Phone:516-526-0845
Mailing Address - Fax:
Practice Address - Street 1:108 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3543
Practice Address - Country:US
Practice Address - Phone:516-526-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach