Provider Demographics
NPI:1861766420
Name:FIELDS, SHINISE
Entity type:Individual
Prefix:
First Name:SHINISE
Middle Name:
Last Name:FIELDS
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 1:3100 RITCHIE RD STE I
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4400
Mailing Address - Country:US
Mailing Address - Phone:240-619-2071
Mailing Address - Fax:240-619-2178
Practice Address - Street 1:3100 RITCHIE RD STE I
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4400
Practice Address - Country:US
Practice Address - Phone:240-619-2071
Practice Address - Fax:240-619-2178
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy