Healthcare Provider Details

I. General information

NPI: 1336061142
Provider Name (Legal Business Name): SHAYNE ALEXANDER FRONHEISER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAYNE ALEXANDER CAMPER

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 N BUTLER AVE STE 105
FARMINGTON NM
87401-6425
US

IV. Provider business mailing address

1029 FRANCES AVE
LANCASTER PA
17601-4538
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-6094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: