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General NPI Number Information
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NPI Number | 1154056695
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Entity Type | Organization
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Legal Business Name | SHINE MEDICAL OF TEXAS, P.A.
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2911 TURTLE CREEK BLVD STE 300
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City | DALLAS
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State | TX
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Zip | 75219-6243
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Country | US
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Telephone | 909-442-0618
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Fax |
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Provider Business Mailing Address
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Address Line | 122 GRAND ST
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City | NEW YORK
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State | NY
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Zip | 10013-2614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS ASSOCIATE
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Name | KATHERINE CASSIDY
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Credential |
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Telephone | 856-287-8167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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