Provider Demographics
NPI:1336128297
Name:SHINE, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:SHINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHURCH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3330
Mailing Address - Country:US
Mailing Address - Phone:203-752-3100
Mailing Address - Fax:203-752-9291
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-752-9291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02892Medicare UPIN