Tiffany Kelly Shields, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN18276 Issued in FL

Practice address

3940 San Jose Park Dr
Jacksonville, FL 32217-4613

Phone

(904) 731-0777

Fax

(904) 731-0142

NPI assigned

Jun 23, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tiffany Lynn Kelly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286496000000",
    "number": "1336300250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3940 SAN JOSE PARK DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174613",
            "telephone_number": "904-731-0777",
            "fax_number": "904-731-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 SAN JOSE PARK DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174613",
            "telephone_number": "904-731-0777",
            "fax_number": "904-731-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "TIFFANY",
        "middle_name": "KELLY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2010-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "KELLY",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Akram M. Shibani, MD
• Katherine Lanier Shibani, APRN
• Joseph R Shiber, MD
• Marshall Shieh
• Kevin Edward Shiel, PT
• Trachele Shields
• Susana Shih
• Mozetta C Shiloh
• Meredith Shimp, DPT
• Karen S Shimshak, MD

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.