DR. BLYNN LEWIS SHIDELER III MD
NPI 1922859388
Student in an Organized Health Care Education/Training Program in Durham, NC

Q: What is Blynn Shideler's NPI number?

The NPI number for Blynn Shideler is 1922859388. It was assigned to this individual provider in the NPPES registry on April 1, 2024.

Q: What is Blynn Shideler's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Blynn Shideler was last updated on April 1, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 01, 2024PECOS Enrolled

2301 ERWIN RD, DURHAM, NC 27705(919) 684-8111 Get Directions Write a Review

NPPES record last updated: April 1, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Dr. Blynn Lewis Shideler Iii Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BLYNN LEWIS SHIDELER III MD (NPI 1922859388) is an individual student in an organized health care education/training program in Durham, North Carolina and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922859388

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. BLYNN LEWIS SHIDELER IIICredential: MD

Location Address2301 ERWIN RDDurham, NC 27705-4699

Mailing Address1940 Lake Marshall DrGibsonia, PA 15044-7433

Phone(919) 684-8111

Sole ProprietorYes

Enumeration DateApril 1, 2024

NPPES CertifiedApril 1, 2024

✔ NPI 1922859388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

2301 ERWIN RD, Durham, NC 27705

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Blynn Lewis Shideler Iii Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.