Provider Demographics
NPI:1407062755
Name:SHINNERS, JENNIFER N (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SHINNERS
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 1:71 U.S. ROUTE ONE, SUITE A
Mailing Address - Street 2:ELEVATION CENTER
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9375
Mailing Address - Country:US
Mailing Address - Phone:207-885-8400
Mailing Address - Fax:207-885-8499
Practice Address - Street 1:71 U.S. ROUTE ONE, SUITE A
Practice Address - Street 2:ELEVATION CENTER
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9375
Practice Address - Country:US
Practice Address - Phone:207-885-8400
Practice Address - Fax:207-885-8499
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117580000Medicaid
ME000342902Medicare PIN
ME117580000Medicaid