Active NPI
Daniel Shea Wines
- Clinical Psychologist
- Goldsboro, NC
National Provider Identifier
1629158274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 439
- Practice address
- 201 Stevens Mill Rd
Goldsboro, NC 27530-1056 - Phone
- (919) 731-3521
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 439 | NC | Primary |
Addresses
Primary practice location
201 Stevens Mill Rd
Goldsboro, NC 27530-1056
Mailing address
1703 Scotty Dr
Goldsboro, NC 27534-3334
Phone (919) 731-3521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 439 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1629158274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 SCOTTY DR",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275343334",
"telephone_number": "919-731-3521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 STEVENS MILL RD",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275301056",
"telephone_number": "919-731-3521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WINES",
"first_name": "DANIEL",
"middle_name": "SHEA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.