Provider Demographics
NPI:1386663672
Name:SHINDO, MAISIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAISIE
Middle Name:L
Last Name:SHINDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD PV01
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-2544
Mailing Address - Fax:503-494-4631
Practice Address - Street 1:3181 SW SAM JACKSON PARK ROAD PV01
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-2544
Practice Address - Fax:503-494-4631
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205752207Y00000X
ORMD28632207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01716861Medicaid
OR024306Medicaid
NY4638790OtherAETNA
NY01Z212OtherEMPIRE BC.BS
NYF16318Medicare UPIN
NY4638790OtherAETNA
NY01Z211Medicare ID - Type Unspecified