Elliot Abraham Shine, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

064060 Issued in NY

Practice address

25 S Oyster Bay Rd
Syosset, NY 11791-5002

Phone

(516) 365-5439

NPI assigned

Jun 14, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shine Pediatric Dentistry

  • Pediatric Dentistry
  • Bayside, NY
  • NPI 1104758317
  NPD Authorized official
• Kiddsmiles II PLLC

  • Pediatric Dentistry
  • Manhasset, NY
  • NPI 1962892901
  NPD (past)
• Kiddsmiles PLLC

  • Dental Clinic/Center
  • Manhasset, NY
  • NPI 1073729794
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723334400000",
    "number": "1548990476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 MARTIN CT",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110241620",
            "telephone_number": "516-695-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S OYSTER BAY RD",
            "city": "SYOSSET",
            "state": "NY",
            "postal_code": "117915002",
            "telephone_number": "516-365-5439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Northern Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Manhasset",
            "state": "NY",
            "postal_code": "110303001",
            "country_code": "US",
            "telephone_number": "516-365-5439",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 Riverside Blvd",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100691001",
            "country_code": "US",
            "telephone_number": "212-810-6562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHINE",
        "first_name": "ELLIOT",
        "middle_name": "ABRAHAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-14",
        "last_updated": "2024-08-11",
        "certification_date": "2024-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02998400",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "27287",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "064060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYEE IDENTIFICATION NUMBER",
            "identifier": "13-3971298",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Alysse Shein, PA
• Alla M Shenkman, MD
• Adam Sherwood, MD
• Rimma Sheshelovskaya, DDS
• Shine Dental Associates of the North Shore
• Alene S Shorin, LCSW
• Robert N Shorin, MSW
• Shuriz Hishmeh MD PLLC
• Firdaus Siddiki
• Kostas Sideridis, DO

• Pediatric Dentistry in Syosset, NY
• Providers in Syosset, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.