Provider Demographics
NPI:1881018745
Name:SHINE, LINDSEY KAY (AUD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:KAY
Last Name:SHINE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:STICKANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH ST STE 3000
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2207
Practice Address - Country:US
Practice Address - Phone:317-948-3226
Practice Address - Fax:888-887-0932
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002549A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201223760Medicaid