Shedrick D Shields, PHD, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP9168218 Issued in FL

Practice address

3363 Dione St
West Melbourne, FL 32904-7582

Phone

(904) 477-3138

NPI assigned

May 24, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mobile Practitioners Group Inc

  • Family Nurse Practitioner
  • West Melbourne, FL
  • NPI 1841827789
  Medicare reassignment NPD Authorized official
• Aegis Care Services

  • Developmentally Disabled Services Day Training Agency
  • Palm Bay, FL
  • NPI 1639057672
  NPD Authorized official
• Oahu Home Care LLC

  • Home Health Agency
  • Melbourne, FL
  • NPI 1073921284
  NPD (past)
• Pophealthcare, LLC

  • Primary Care Nurse Practitioner
  • Jacksonville, FL
  • NPI 1326617150
  NPD (past)

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

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1902125446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3363 DIONE ST",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329047582",
            "telephone_number": "904-477-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3363 DIONE ST",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329047582",
            "telephone_number": "904-477-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "SHEDRICK",
        "middle_name": "D",
        "credential": "PHD, APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-24",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9168218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002286300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vierge Audrey Selexant
• Justin Settle, PHARM. D
• Anand Shah, DMD
• Shangri-la of West Melbourne Alf, LLC
• Lauren Marina Shaw, MASSAGE THERAPIST
• Georgia Shifflette, ARNP
• Craig F Sicinski, RPH
• Ashley Kian Simmons
• Jeanne M Simpson, LCSW
• Sheetal R Singla

• Nurse Practitioner in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.