Healthcare Provider Details

I. General information

NPI: 1902663735
Provider Name (Legal Business Name): SHELBY H CLINE MD PA D/B/A SUNSHINE PEDIATRICS OF ST AUGUSTINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WHITEHALL DR STE 108
SAINT AUGUSTINE FL
32086-5268
US

IV. Provider business mailing address

101 WHITEHALL DR STE 108
SAINT AUGUSTINE FL
32086-5268
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-2207
  • Fax:
Mailing address:
  • Phone: 904-615-1794
  • Fax: 904-341-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE MANUCY
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-615-1794