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General NPI Number Information
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NPI Number | 1538317698
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Entity Type | Individual
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Provider Name | DAVID SHANE TYSINGER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 1581 YANCEYVILLE ST
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City | GREENSBORO
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State | NC
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Zip | 27405-6958
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Country | US
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Telephone | 336-275-6445
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Fax | 336-275-3012
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone | 336-832-7000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-01513
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License Number State | NC
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