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SHINE PEDIATRICS AND WELLNESS CENTER P.A. NPI 1609110832


NPI Information

NPI: 1609110832
Provider Name: SHINE PEDIATRICS AND WELLNESS CENTER P.A.
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 45D2232281

Address:
3600 SHIRE BLVD
SUITE 110
RICHARDSON, TX
ZIP 75082
Phone: (469) 333-1543
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SHINE PEDIATRICS AND WELLNESS CENTER P.A. is a pediatrics in Richardson, TX. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SHINE PEDIATRICS AND WELLNESS CENTER P.A. NPI is 1609110832. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3600 SHIRE BLVD
SUITE 110
RICHARDSON, TX
ZIP 75082-240
Phone: (469) 333-1543
Fax: (877) 878-9118

The provider's authorized official is Randy Naidoo .
The authorized official title is President and has the following contact phone number (469) 939-6336.

The CLIA number assigned to this NPI record is 45D2232281 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/9/2012 and was last updated on 8/10/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsM0506TEXASNo
22084P0800XPsychiatry & NeurologyPsychiatryNo
32084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
4208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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