Provider Demographics
NPI:1770657017
Name:SHINAVER, CHARLES S III (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:SHINAVER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 ANTIQUITY DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3403
Mailing Address - Country:US
Mailing Address - Phone:317-641-7794
Mailing Address - Fax:317-641-7794
Practice Address - Street 1:6911 ANTIQUITY DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-3403
Practice Address - Country:US
Practice Address - Phone:317-641-7794
Practice Address - Fax:317-641-7794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041158A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical