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General NPI Number Information
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NPI Number | 1851172779
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Entity Type | Organization
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Legal Business Name | CNY SHINE PHYSICAL OCCUPATIONAL AND SPEECH THERAPY PLLC
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 3400 VICKERY RD STE E
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4526
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Country | US
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Telephone | 315-806-0756
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 VICKERY RD STE E
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4534
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Country | US
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Telephone | 315-214-4482
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Fax | 315-299-4096
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Authorized Official
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Title or Position | PARTNER/OWNER/DPT
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Name | AMANDA MILLER
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Credential | DPT
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Telephone | 315-806-0756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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