Provider Demographics
NPI:1770984346
Name:SHIELDS, DEBORAH L (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:SHIELDS
Suffix:
Gender:F
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 1:464 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POINT ROBERTS
Mailing Address - State:WA
Mailing Address - Zip Code:98281-8808
Mailing Address - Country:US
Mailing Address - Phone:206-387-5033
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2501
Practice Address - Fax:360-428-2596
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT363A00000X
WAPA60831969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant