Provider Demographics
NPI:1942247127
Name:SHIELDS & FIDANZA, LLC
Entity type:Organization
Organization Name:SHIELDS & FIDANZA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONTRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-345-8544
Mailing Address - Street 1:3211 CROSSHILL CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8174
Mailing Address - Country:US
Mailing Address - Phone:502-345-8544
Mailing Address - Fax:
Practice Address - Street 1:CHAMPION FARMS DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-345-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty