NPIMap

Organization Active NPI

Shine Pediatrics and Wellness Center P.a.

  • Pediatrics Physician
  • Richardson, TX
National Provider Identifier
1609110832
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SHINE PEDIATRICS AND WELLNESS CENTER P.A.
Practice address
3600 Shire Blvd
Suite 110
Richardson, TX 75082-2240
Phone
(469) 333-1543
Fax
(877) 878-9118
NPI assigned
Nov 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Authorized official

Name
Dr. Randy Naidoo, M.D.NPI 1104830033
Title
President
Phone
(469) 939-6336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X M0506 TX
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

3600 Shire Blvd
Suite 110
Richardson, TX 75082-2240

Mailing address

3600 Shire Blvd
Suite 110
Richardson, TX 75082-2240
Phone (469) 333-1543

Other practice location 1

5009 Byers Ave
Fort Worth, TX 76107-3625
Phone (469) 333-1543

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2057774Shine Pediatrics and Wellness Center, PA3600 Shire Blvd, Ste 110, Richardson, TX 75082Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory

Locations

5009 Byers Ave
Fort Worth, TX 76107
Phone (469) 333-1543

3600 Shire Blvd
Ste 110
Richardson, TX 75082
Phone (469) 333-1543

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1609110832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822240",
            "telephone_number": "469-333-1543",
            "fax_number": "877-878-9118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822240",
            "telephone_number": "469-333-1543",
            "fax_number": "877-878-9118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5009 Byers Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761073625",
            "country_code": "US",
            "telephone_number": "469-333-1543",
            "fax_number": "877-878-9118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHINE PEDIATRICS AND WELLNESS CENTER P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "NAIDOO",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-939-6336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M0506",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.