Provider Demographics
NPI:1568050508
Name:SHINGLETON, BRIAN LEE
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:SHINGLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-9026
Mailing Address - Country:US
Mailing Address - Phone:304-573-0953
Mailing Address - Fax:
Practice Address - Street 1:583 TIMBER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-9026
Practice Address - Country:US
Practice Address - Phone:304-573-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant