Provider Demographics
NPI:1629097175
Name:SHINAULT, RHONDA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:L
Last Name:SHINAULT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:L
Other - Last Name:PAUPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:815 ST JOSEPH DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-983-3455
Mailing Address - Fax:269-983-5920
Practice Address - Street 1:520 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1490
Practice Address - Country:US
Practice Address - Phone:269-427-5811
Practice Address - Fax:269-427-6107
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629097175Medicaid
MI5601004817OtherPHYS. ASST. LICENSE NUMB
MIP00888250OtherRR
MI1629097175Medicaid