Provider Demographics
NPI:1992904809
Name:SHINE, NORA ESPERANZA (PHD)
Entity type:Individual
Prefix:DR
First Name:NORA
Middle Name:ESPERANZA
Last Name:SHINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOBURN ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3026
Mailing Address - Country:US
Mailing Address - Phone:781-245-0326
Mailing Address - Fax:781-872-1009
Practice Address - Street 1:22 WOBURN ST
Practice Address - Street 2:SUITE 34
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3026
Practice Address - Country:US
Practice Address - Phone:781-245-0326
Practice Address - Fax:781-872-1009
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8699103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist