Healthcare Provider Details

I. General information

NPI: 1205815990
Provider Name (Legal Business Name): ANTONY EDWIN SHRIMPTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST CLINICAL PATHOLOGY
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

321 MCLENNAN DR
FAYETTEVILLE NY
13066-1238
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6807
  • Fax: 315-464-6827
Mailing address:
  • Phone: 315-632-4172
  • Fax: 315-464-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number93270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: