Shunrie Geldore, PHYSICIAN ASSISTANT
Individual provider Active NPI Physician Assistant · Edwards Afb, CA
NPI 1780958645 · NPPES record last updated Feb 23, 2012
Key facts
- NPI
- 1780958645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 30 Nightingale Rd
Edwards Afb, CA 93524-0001 - Phone
- (661) 275-7938
- NPI assigned
- Feb 23, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
30 Nightingale Rd
Edwards Afb, CA 93524-0001
Mailing address
30 Nightingale Rd
Edwards Afb, CA 93524-0001
Other providers in Edwards Afb, CA
- David I Davamony
- Asit Hirenkumar Dave
- Karen Ann Desocio
- James Randall Elliott
- Joshua Chad Ford
- Kallyn Dorothy Harencak
- Michael Hasler
- Arlene Johnson
- Ain Kang
- Jun Kyung Ko
All providers in Edwards Afb, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.