MR. RANDY SHINE (NPI# 1417126624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417126624 |
| Entity Type | Individual |
| Full Name | MR. RANDY SHINE |
| Practice Address |
430 Niagara Street Blended Case Management Buffalo NY 14201 |
| Mailing Address |
254 Franklin Street Lake Shore Behavioral Health Buffalo NY 14202 |
| Practice Telephone | 7168562587 |
| Practice Fax Number | 7168562608 |
| Mailing Telephone | 7168420440 |
| Mailing Fax Number | 7168424069 |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
430 NIAGARA STREET BLENDED CASE MANAGEMENT |
| City | BUFFALO |
| State | NY |
| Zip Code | 14201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669561551 | Sandra Stephens | Registered Nurse | 430 Niagara Street, Act Program, Buffalo, NY 14201 | 2006-10-11 |
| 1336611607 | Aaron Eric Zakrzewski | Music Therapist | 430 Niagara Street, Buffalo, NY 14201 | 2018-12-26 |
| 1770923799 | Margery Stanton | Counselor | 430 Niagara Street, Buffalo, NY 14201 | 2013-07-05 |
| 1336483452 | Taunya Clarke | Social Worker | 430 Niagara Street, Buffalo, NY 14201 | 2012-11-15 |
| 1629361068 | Timothy Govenettio | Registered Nurse | 430 Niagara Street, Buffalo, NY 14201 | 2011-05-18 |
| 1164680666 | Kathleen Mary Minyard | Registered Nurse | 430 Niagara Street, Act Program, Buffalo, NY 14201 | 2008-05-30 |
| 1184897258 | Lake Shore Behavioral Health | Private Vehicle | 430 Niagara Street, Transportation, Buffalo, NY 14201 | 2008-04-09 |
| 1508037060 | Annie Williams | Registered Nurse | 430 Niagara Street, Act Program, Buffalo, NY 14201 | 2008-03-12 |
| 1598934705 | Enelida Rodriguez | Case Manager/Care Coordinator | 430 Niagara Street, Blended Case Management, Buffalo, NY 14201 | 2008-02-22 |
| 1518142728 | Andrea Elizabeth Born | Counselor | 430 Niagara Street, Buffalo, NY 14201 | 2008-01-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619592201 | Linda Berkoh-asamoah | Nurse Practitioner | Evergreen Health Services, 206 S. Elmwood Avenue, Buffalo, NY 14201 | 2020-06-10 |
| 1790223303 | Walaa Kadhum | Social Worker | 340 Niagara Street, Buffalo, NY 14201 | 2017-02-02 |
| 1285171025 | Santina Grace Phillips | Counselor | 10 Symphony Circle, Buffalo, NY 14201 | 2017-01-31 |
| 1073976759 | Jana Riesterer | Social Worker | 254 Virginia Street, Buffalo, NY 14201 | 2016-03-31 |
| 1710309414 | Chs N.y. Medical P.C. | General Practice | 10 Sheridan Rd, Buffalo, NY 14201 | 2014-01-15 |
| 1467722314 | Kristin Nicole Halter | Counselor | 591 Niagara Street, Buffalo, NY 14201 | 2012-01-10 |
| 1538446844 | Robert Martin Kennuth | Specialist/Technologist | 329 Porter Ave, D'youville College, Buffalo, NY 14201 | 2011-11-15 |
| 1902115033 | James W Burcher | Registered Nurse | 430 Niagara, Buffalo, NY 14201 | 2010-10-07 |
| 1336468115 | Jane Leslie Burgio | Speech-Language Pathologist | 315 Carolina St, Buffalo, NY 14201 | 2010-05-19 |
| 1376787044 | Jessica Christina | Licensed Practical Nurse | 85 Johnson Park, Buffalo, NY 14201 | 2009-04-26 |
| Find all providers in zip 14201 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154933042 | Jeanie Herman | Case Manager/Care Coordinator | 170 S Lobban Ave, Buffalo, WY 82834-1915 | 2020-08-20 |
| 1780202739 | Karen Kristina Younus | Case Manager/Care Coordinator | 255 Delaware Ave Ste 204, Buffalo, NY 14202-2017 | 2020-07-07 |
| 1275008963 | Priscilla Celeste Delgado | Case Manager/Care Coordinator | 777 Fort St, Buffalo, WY 82834-2369 | 2018-10-09 |
| 1548756562 | Amber Fortunato | Case Manager/Care Coordinator | 338 Harris Road Suite 101, Buffalo, NY 14221 | 2018-07-02 |
| 1154849305 | Yasmin Rivera | Case Manager/Care Coordinator | 368 Rhode Island St, Apt 2, Buffalo, NY 14213 | 2017-09-07 |
| 1205370590 | Mary Ann Jones | Case Manager/Care Coordinator | 1964 Brooks Rd, 1964 Brooks Rd, Buffalo, KY 42716-8124 | 2016-12-06 |
| 1063960169 | Amanda Simondi | Case Manager/Care Coordinator | 174 Glencoe Way, Buffalo, WY 82834-9389 | 2016-09-17 |
| 1124576319 | Melody Donahue | Case Manager/Care Coordinator | 155 E Keays St, Buffalo, WY 82834-1900 | 2016-09-15 |
| 1710396668 | Kathleen Brown | Case Manager/Care Coordinator | 2643 Main St, Buffalo, NY 14214-2015 | 2014-08-05 |
| 1215286265 | Janel M Delair | Case Manager/Care Coordinator | 95 Franklin St Rm 828, Buffalo, NY 14202-3904 | 2012-09-06 |
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| 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.