SHORELINES (NPI# 1225675861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225675861 |
| Entity Type | Organization |
| Organization Name | SHORELINES |
| Other Organization Name | SHORELINES |
| Practice Address |
500 N Rainbow Blvd Las Vegas NV 89107-1082 |
| Mailing Address |
500 N Rainbow Blvd Ste 300-345 Las Vegas NV 89107-1082 |
| Practice Telephone | 8436193571 |
| Mailing Telephone | 8332468353 |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2020-09-08 |
| Authorized Official Name | DR. MEREDITH D'AGOSTINO (PRACTICE OWNER) |
| Authorized Official Telephone | 8436193571 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 1871752303 | 05 | |
| NV | NV - APRN LICENSE | 816203 | 01 |
| Other Name | Type Code |
|---|---|
| Shorelines | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Shorelines by Design Inc. | Po Box 314, Bracey, Virginia 23919 |
| Washington State Corporations | SHORELINES MARKETING, INC. | 258 Sw 43rd St Ste A, Renton, WA 98055 |
| Oregon Corporations, Companies and Business Names | SHORELINES NW, LLC | 172 N Hemlock St, Cannon Beach, OR 97110 |
| Street Address |
500 N RAINBOW BLVD |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89107-1082 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447224431 | Emmanuel K Onwutuebe | Internal Medicine | 500 N Rainbow Blvd, Suite 300, Las Vegas, NV 89107-1082 | 2006-02-15 |
| 1821635103 | Yariv Sponko | Technician | 500 N Rainbow Blvd, Ste 300, Las Vegas, NV 89107 | 2019-12-05 |
| 1083270193 | National Youth Advocate Program, Inc | Community/Behavioral Health | 500 N Rainbow Blvd, Las Vegas, NV 89107-1082 | 2019-05-14 |
| 1881188688 | Dora Ashley Marroquin | Technician | 500 N Rainbow Blvd, Las Vegas, NV 89107-1082 | 2018-06-15 |
| 1669919577 | Natalie Rae Bohn | Physician Assistant | 500 N Rainbow Blvd, Las Vegas, NV 89107-1082 | 2017-01-30 |
| 1235676610 | Kyle Martineau | Physician Assistant | 500 N Rainbow Blvd, 303, Las Vegas, NV 89107-1082 | 2017-01-24 |
| 1053856179 | Idealstaffing Inc | Home Health | 500 N Rainbow Blvd, Suite 300, Las Vegas, NV 89107-1082 | 2016-12-28 |
| 1740722461 | Gregory Allan Barnes | Physician Assistant | 500 N Rainbow Blvd, Ste. 203, Las Vegas, NV 89107-1082 | 2016-11-11 |
| 1578012670 | Oganes Shilgevorkyan Md Pllc | Family Medicine | 500 N Rainbow Blvd, Suite 300, Las Vegas, NV 89107-1082 | 2016-09-29 |
| 1730539909 | Shanda Wolfe | Behavioral Analyst | 500 N Rainbow Blvd, Suite 300, Las Vegas, NV 89107-1082 | 2016-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942837620 | Dominica Marie Lemay | Technician | Ideal Staffing Inc 500 N Rainbow Blvd Ste 300 Las Vegas, Las Vegas, NV 89107 | 2020-03-24 |
| 1417589854 | Ciro Zuniga | Technician | 5020 Alta Dr Suit-b, Las Vegas, NV 89107 | 2020-02-04 |
| 1730729252 | Natalie Rochelle Ross | Technician | Ideal Staffing Inc N Rainbow Blvd Ste 300 Las Vegas, Nv, Las Vegas, NV 89107 | 2020-01-13 |
| 1679112148 | Cynthia Mayen | Technician | 2050 Alta Dr. Suit - B, Las Vegas, NV 89107 | 2020-01-02 |
| 1427695543 | Aaa Physical Therapy LLC | Clinic/Center | 633 N. Decatur Blvd., Suite E, Las Vegas, NV 89107 | 2019-12-09 |
| 1063061018 | Guaoalupe Pena | Technician | 5020 Alta Dr. Suit - B, Las Vegas, NV 89107 | 2019-09-11 |
| 1275180234 | Roman Bautista Ortiz | Technician | 5020 Alta Dr. Suit-b, Las Vegas, NV 89107 | 2019-08-23 |
| 1518513357 | Michele Renee Black | Chore Provider | 500 North Rainbow Boulevard, Suite 300, Las Vegas, NV 89107 | 2019-08-16 |
| 1124674312 | Helena Alma Ferron-zepeda | Technician | 5020 Alta Dr., Suite-b, Las Vegas, NV 89107 | 2019-08-13 |
| 1386299246 | Felecia Ann Goodwin | Technician | 500 N Rainbow Blvd Ste 300, Ideal Staffing Inc, Las Vegas, NV 89107 | 2019-08-07 |
| Find all providers in zip 89107 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404074 | Ibukun Odutola | Nurse Practitioner | 2605 E Flamingo Rd, Las Vegas, NV 89121-5241 | 2020-07-14 |
| 1225652191 | Angela Beth Wilson | Nurse Practitioner | 5440 W Sahara Ave Ste 220, Las Vegas, NV 89146-0355 | 2020-06-05 |
| 1104445394 | Universal Psychiatry LLC | Nurse Practitioner | 270 E Flamingo Rd Unit 122, Las Vegas, NV 89169-0325 | 2020-04-09 |
| 1952931271 | Paramount Healthcare Services Corp | Nurse Practitioner | 10141 Rockridge Peak Ave, Las Vegas, NV 89166-5200 | 2020-01-26 |
| 1730642182 | Aban Medical Services | Nurse Practitioner | 10145 Eagle Haven St, Las Vegas, NV 89141-8781 | 2019-04-11 |
| 1750857728 | Jan Michael Arceo | Nurse Practitioner | 3140 S Rainbow Blvd Ste 401, Las Vegas, NV 89146-6234 | 2018-10-17 |
| 1780110247 | Jon A Failla Aprn Pllc | Nurse Practitioner | 182 Apache Tear Ct, Las Vegas, NV 89123-2996 | 2017-05-03 |
| 1023565074 | Bright Star Nurse Care LLC | Nurse Practitioner | 8337 Fox Brook St, Las Vegas, NV 89139-6755 | 2016-09-07 |
| 1467805119 | Kasey James Dean | Nurse Practitioner | 3321 N Buffalo Dr, Suite 200, Las Vegas, NV 89129-6678 | 2016-07-18 |
| 1558757021 | Martin Binyange | Nurse Practitioner | 320 E Warm Springs Rd Unit 1, Las Vegas, NV 89119-4243 | 2015-04-12 |
| Find all providers in LAS VEGAS | ||||
Please comment or provide details below to improve the information on SHORELINES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.