Provider Demographics
NPI:1679023121
Name:SHINAULT, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:SHINAULT
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 1:2360 CARDIGAN DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7419
Mailing Address - Country:US
Mailing Address - Phone:901-828-0584
Mailing Address - Fax:901-328-8821
Practice Address - Street 1:2360 CARDIGAN DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7419
Practice Address - Country:US
Practice Address - Phone:901-828-0584
Practice Address - Fax:901-328-8821
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN078652551171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor