Provider Demographics
NPI:1538519954
Name:PHILIP, SHINE (NP)
Entity type:Individual
Prefix:
First Name:SHINE
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-2912
Mailing Address - Country:US
Mailing Address - Phone:203-276-2516
Mailing Address - Fax:203-276-2515
Practice Address - Street 1:75 HOLLY HILL LN STE 201
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2912
Practice Address - Country:US
Practice Address - Phone:203-276-2516
Practice Address - Fax:203-276-2515
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13204363LF0000X
NYF341575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily