Provider Demographics
NPI:1831984541
Name:SHINNEMAN, JOSHUA MATTHEW
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MATTHEW
Last Name:SHINNEMAN
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 1:2716 CINTOIA DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2042
Mailing Address - Country:US
Mailing Address - Phone:775-200-2480
Mailing Address - Fax:775-591-5988
Practice Address - Street 1:1625 E PRATER WAY STE 103
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8963
Practice Address - Country:US
Practice Address - Phone:775-359-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist