Provider Demographics
NPI:1235965658
Name:SHINE ENTERPRISE EQUIPMENT LLC
Entity type:Organization
Organization Name:SHINE ENTERPRISE EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-946-6434
Mailing Address - Street 1:99 NW 183RD ST STE 131
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4555
Mailing Address - Country:US
Mailing Address - Phone:754-946-6434
Mailing Address - Fax:
Practice Address - Street 1:99 NW 183RD ST STE 131
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4555
Practice Address - Country:US
Practice Address - Phone:754-946-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center