Healthcare Provider Details

I. General information

NPI: 1306190103
Provider Name (Legal Business Name): JOHN SHINNICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 SE COCONUT ST
HOBE SOUND FL
33455-4008
US

IV. Provider business mailing address

8108 SE COCONUT ST
HOBE SOUND FL
33455-4008
US

V. Phone/Fax

Practice location:
  • Phone: 561-312-3940
  • Fax: 772-695-9100
Mailing address:
  • Phone: 561-312-3940
  • Fax: 772-695-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: