| Shine Medical Pc | |
|
1350 Avenue Of The Americas Fl 2 New York NY 10019-4703 | |
| (888) 380-2028 | |
| Not Available |
| Full Name | Shine Medical Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1350 Avenue Of The Americas Fl 2, New York, New York |
| Authorized Official Name and Position | Clare Frances Boals Frye (SVP OF OPERATIONS) |
| Authorized Official Contact | 6166481196 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Medical Pc Po Box 360721 Pittsburgh PA 15251-6721 Ph: () - | Shine Medical Pc 1350 Avenue Of The Americas Fl 2 New York NY 10019-4703 Ph: (888) 380-2028 |
| NPI Number | 1427783950 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 10/04/2024 |
| Certification Date | 10/04/2024 |
| Medicare PECOS PAC ID | 5092253419 |
|---|---|
| Medicare Enrollment ID | O20240816001853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427783950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Stacy Atebefia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891224291 PECOS PAC ID: 9931563749 Enrollment ID: I20230913000198 |
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