Healthcare Provider Details

I. General information

NPI: 1548815756
Provider Name (Legal Business Name): SHANE SHIVA NARINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 MERRICK BLVD FL 6
JAMAICA NY
11432-5363
US

IV. Provider business mailing address

9114 MERRICK BLVD
JAMAICA NY
11432-5363
US

V. Phone/Fax

Practice location:
  • Phone: 718-408-7178
  • Fax: 718-408-7179
Mailing address:
  • Phone: 646-717-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number998586405
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: