Provider Demographics
NPI:1902381486
Name:SHINDLE, ADAM PATRICK
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:PATRICK
Last Name:SHINDLE
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 1:109 JOSEPH FLETCHER WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5467
Mailing Address - Country:US
Mailing Address - Phone:864-979-6079
Mailing Address - Fax:
Practice Address - Street 1:109 JOSEPH FLETCHER WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5467
Practice Address - Country:US
Practice Address - Phone:864-979-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000969367500000X
FLRN9366583163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine