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General NPI Number Information
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NPI Number | 1912177692
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Entity Type | Individual
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Provider Name | MELBA LANIECE SHINE RN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 263 BLUE POINT AVE
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City | BLUE POINT
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State | NY
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Zip | 11715-1224
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Country | US
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Telephone | 631-419-6737
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Fax | 631-868-3498
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Provider Business Mailing Address
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Address Line | 19 SILVERPINE DRIVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-2029
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Country | US
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Telephone | 631-789-2115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 602544
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License Number State | NY
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