Healthcare Provider Details

I. General information

NPI: 1417539024
Provider Name (Legal Business Name): ADELLAIDE SHYNGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 BRIDGE MILL DR SE APT Q
MARIETTA GA
30067-3852
US

IV. Provider business mailing address

2400 HERODIAN WAY SE STE 220
SMYRNA GA
30080-8500
US

V. Phone/Fax

Practice location:
  • Phone: 404-750-6494
  • Fax:
Mailing address:
  • Phone: 404-750-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN274753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: