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NPI Code Detail

MEDICARE: SHINE MEDICAL OF TEXAS, P.A.

MEDICARE: SHINE MEDICAL OF TEXAS, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1154056695
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHINE MEDICAL OF TEXAS, P.A.
Provider Business Mailing Address
First Line : 122 GRAND ST
Second Line :
City : NEW YORK
State : NY
Zip : 10013-2614
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2911 TURTLE CREEK BLVD STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75219-6243
Country : US
Telephone Number : 909-442-0618
Fax Number :
Authorized Official
Title or Position : CLINICAL OPERATIONS ASSOCIATE
Name : KATHERINE CASSIDY
Credential :
Telephone Number : 856-287-8167
Provider Enumeration Date : 07/19/2022
Last Update Date : 09/16/2022

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Directions to “SHINE MEDICAL OF TEXAS, P.A. ” Practice Location

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