Provider Demographics
NPI:1215635354
Name:SHINDER, MYRIAH
Entity type:Individual
Prefix:
First Name:MYRIAH
Middle Name:
Last Name:SHINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29850
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55429-0850
Mailing Address - Country:US
Mailing Address - Phone:612-221-9350
Mailing Address - Fax:
Practice Address - Street 1:6826 HUMBOLDT AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1536
Practice Address - Country:US
Practice Address - Phone:612-221-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No171W00000XOther Service ProvidersContractor
No372500000XNursing Service Related ProvidersChore Provider