Provider Demographics
NPI:1730930918
Name:SHINE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:SHINE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-363-1390
Mailing Address - Street 1:21456 DANBURY ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1608
Mailing Address - Country:US
Mailing Address - Phone:734-363-1390
Mailing Address - Fax:
Practice Address - Street 1:21456 DANBURY ST
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1608
Practice Address - Country:US
Practice Address - Phone:734-363-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment