MEDICARE: DAVID SHANE TYSINGER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0010-01513	NC

General Provider Information

NPI Number	:	1538317698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SHANE TYSINGER PA-C

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1581 YANCEYVILLE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6958
Country	:	US
Telephone Number	:	336-275-6445
Fax Number	:	336-275-3012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/28/2021

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