Provider Demographics
NPI:1740246628
Name:SHINNICK, JOSEPH PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:SHINNICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 ORANGE ZONE TRENT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-1004
Mailing Address - Fax:919-684-8280
Practice Address - Street 1:5327 ORANGE ZONE TRENT DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-1004
Practice Address - Fax:919-684-8280
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759175AMedicare PIN
NCS22225Medicare UPIN