Shine Pediatrics, PLLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Legal business name

SHINE PEDIATRICS, PLLC

Practice address

1600 116TH Ave NE Ste 304
Bellevue, WA 98004-3057

Phone

(225) 715-5242

NPI assigned

Jan 31, 2024

Organization subpart

No

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

Authorized official

Name

Staci Swan, ARNPNPI 1235562711

Title

Co-Owner, Arnp

Phone

(225) 715-5242

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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

• Staci H Swan

  • Pediatric Nurse Practitioner
  • Bellevue, WA
  • NPI 1235562711

  Pediatrics

  Medicare reassignment NPD Authorized official
• Natalie Burleson

  • Pediatric Nurse Practitioner
  • Bellevue, WA
  • NPI 1053954958

  Pediatrics

  Medicare reassignment NPD
• Tessa Mae Hart

  • Pediatric Nurse Practitioner
  • Meridian, ID
  • NPI 1356208516

  WA

  Medicare reassignment

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1821851239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25676 SE 149TH ST",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 116TH AVE NE STE 304",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043057",
            "telephone_number": "225-715-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "SWAN",
        "authorized_official_first_name": "STACI",
        "authorized_official_title_or_position": "CO-OWNER, ARNP",
        "authorized_official_telephone_number": "225-715-5242",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole B. Shin, M.D.
• Sangheon Shin, CH61383071
• Sarah Eunhae Shin
• Sun Hwa Shin
• Shine Aesthetic School
• Louis Scott Cook Shinneman, M.D.
• Brianna Larrabee Shinners
• Eric R Shipley, MD
• Emily Shirai, LMHCA
• Bryan Shireman, D.D.S

• Pediatric Nurse Practitioner in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.