Provider Demographics
NPI:1083157630
Name:SHINE THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:SHINE THERAPY CENTER, INC.
Other - Org Name:SHINE THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER/SLP
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SHAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD, CCC-SLP
Authorized Official - Phone:707-474-9949
Mailing Address - Street 1:183 BUTCHER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5690
Mailing Address - Country:US
Mailing Address - Phone:707-474-9949
Mailing Address - Fax:
Practice Address - Street 1:183 BUTCHER RD
Practice Address - Street 2:SUITE B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5690
Practice Address - Country:US
Practice Address - Phone:707-474-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty