| Lyea Dorae Shine, | |
|
502 Mccurry St, Pleasant Hope, MO 65725-9231 | |
| (904) 254-3686 | |
| Not Available |
| Full Name | Lyea Dorae Shine |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 4 Years |
| Location | 502 Mccurry St, Pleasant Hope, Missouri |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396346870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 2014029095 (Missouri) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 811313 (New York) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| University Hospital S U N Y Health Science Center | Syracuse, NY | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Chag Anesthesia Pc | 2668361973 | 45 |
| Agcny Physicians Pllc | 4284804345 | 29 |
| Entity Name | North American Partners In Anesthesia Llp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649264706 PECOS PAC ID: 7719885771 Enrollment ID: O20040108000176 |
| Entity Name | Chag Anesthesia Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1740279017 PECOS PAC ID: 2668361973 Enrollment ID: O20040315000126 |
| Entity Name | Syracuse Gastroenterological Associates.pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1619947843 PECOS PAC ID: 6305814716 Enrollment ID: O20040923000422 |
| Entity Name | Agcny Physicians Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033497136 PECOS PAC ID: 4284804345 Enrollment ID: O20110826000658 |
| Entity Name | Genesee Physician Practice Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598138356 PECOS PAC ID: 6002114774 Enrollment ID: O20160413000238 |
| Mailing Address | Practice Location Address |
|---|---|
| Lyea Dorae Shine, Po Box 68, Fayetteville, NY 13066-0068 Ph: (904) 254-3686 | Lyea Dorae Shine, 502 Mccurry St, Pleasant Hope, MO 65725-9231 Ph: (904) 254-3686 |