Healthcare Provider Details

I. General information

NPI: 1750366829
Provider Name (Legal Business Name): CHRISTINA N. SHINAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 TECHNOLOGY CENTER DRIVE
INDIANAPOLIS IN
46278-6013
US

IV. Provider business mailing address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

V. Phone/Fax

Practice location:
  • Phone: 317-328-5050
  • Fax: 317-715-9965
Mailing address:
  • Phone: 786-596-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME154026
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01044773A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME154026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: