Provider Demographics
NPI:1164578522
Name:SHINNEY, ROBERT D (STUDENT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:SHINNEY
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 NE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2010
Mailing Address - Country:US
Mailing Address - Phone:503-287-3050
Mailing Address - Fax:
Practice Address - Street 1:1722 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2010
Practice Address - Country:US
Practice Address - Phone:503-287-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program