Healthcare Provider Details

I. General information

NPI: 1548238314
Provider Name (Legal Business Name): DONALD C SHINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR PHYSICIAN PRACTICES, ATTN: CARLA GOMEZ
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-5233
  • Fax: 505-989-6466
Mailing address:
  • Phone: 505-820-5227
  • Fax: 505-820-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number98-165
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: