MEDICARE: SHINY HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1700691052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINY HOMES LLC

Provider Business Mailing Address
First Line	:	1300 WISCONSIN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2555
Country	:	US
Telephone Number	:	234-303-9210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 WISCONSIN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2555
Country	:	US
Telephone Number	:	234-303-9210
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ELHADJ ALPHA MAHMOUD SOUARE
Credential	:
Telephone Number	:	234-303-9210

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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