Healthcare Provider Details

I. General information

NPI: 1639081409
Provider Name (Legal Business Name): JOSHUA SHYNGLE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE # 6702
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

5441 S MACADAM AVE # 6702
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 408-668-2997
  • Fax:
Mailing address:
  • Phone: 408-668-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10007828
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: