Provider Demographics
NPI:1295742310
Name:SHINDLER, SCOTT LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEE
Last Name:SHINDLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:LEE
Other - Last Name:SHINDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:4921 E BELL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6002
Mailing Address - Country:US
Mailing Address - Phone:602-753-9403
Mailing Address - Fax:602-753-9453
Practice Address - Street 1:4921 E BELL RD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-753-9403
Practice Address - Fax:602-753-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD98213E00000X
AZPOD-000988213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE46040987501Medicaid
SD6800030Medicaid
NE278109Medicare PIN
NE46040987501Medicaid
SD0302160001Medicare NSC
SD6800030Medicaid