Provider Demographics
NPI:1902663735
Name:SHELBY H CLINE MD PA D/B/A SUNSHINE PEDIATRICS OF ST AUGUSTINE
Entity type:Organization
Organization Name:SHELBY H CLINE MD PA D/B/A SUNSHINE PEDIATRICS OF ST AUGUSTINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-615-1794
Mailing Address - Street 1:101 WHITEHALL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5268
Mailing Address - Country:US
Mailing Address - Phone:904-615-1794
Mailing Address - Fax:904-341-5552
Practice Address - Street 1:101 WHITEHALL DR STE 108
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5268
Practice Address - Country:US
Practice Address - Phone:904-814-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service