Healthcare Provider Details

I. General information

NPI: 1902381486
Provider Name (Legal Business Name): MR. ADAM PATRICK SHINDLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 JOSEPH FLETCHER WAY
SIMPSONVILLE SC
29681-5467
US

IV. Provider business mailing address

109 JOSEPH FLETCHER WAY
SIMPSONVILLE SC
29681-5467
US

V. Phone/Fax

Practice location:
  • Phone: 864-979-6079
  • Fax:
Mailing address:
  • Phone: 864-979-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000969
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9366583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: