=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790658185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDSHINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 FOREST RIDGE DR
-----------------------------------------------------
City | ROWLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01969-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-356-0315
-----------------------------------------------------
Fax | 978-356-0316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 FOREST RIDGE DR
-----------------------------------------------------
City | ROWLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01969-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-356-0315
-----------------------------------------------------
Fax | 978-356-0316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CLINICIAN
-----------------------------------------------------
Name | AMY WHEADON
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 978-356-0315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------