Basic Information
| Provider Information | |||||||||
| NPI: | 1003139395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHINHAM | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | GIBSON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GIBSON | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4600 SW 46TH CT | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523695999 | ||||||||
| FaxNumber: | 3526294227 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 SW 46TH CT | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523695999 | ||||||||
| FaxNumber: | 3526294227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 03/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9105348 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.