Provider Demographics
NPI:1568082691
Name:SHINNERS, JASON SAMUEL (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SAMUEL
Last Name:SHINNERS
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1715
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:
Practice Address - Street 1:101 NICHOLLS ROAD HSC LEVEL 3
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-1715
Practice Address - Country:US
Practice Address - Phone:631-444-5858
Practice Address - Fax:631-444-1899
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2024-08-15
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY322275207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine