Provider Demographics
NPI:1053175661
Name:SHINABERRY, AUSTIN JORDAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JORDAN
Last Name:SHINABERRY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MIDDLETON DR APT M
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3236
Mailing Address - Country:US
Mailing Address - Phone:386-383-6087
Mailing Address - Fax:
Practice Address - Street 1:188 MIDDLETON DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3236
Practice Address - Country:US
Practice Address - Phone:386-383-6087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant