Healthcare Provider Details

I. General information

NPI: 1225141591
Provider Name (Legal Business Name): STEVE M SHINDELL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW STE 230
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW STE 230
ATLANTA GA
30327-1610
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-0485
  • Fax: 404-605-9695
Mailing address:
  • Phone: 404-605-0485
  • Fax: 404-605-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY001321
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: