Healthcare Provider Details

I. General information

NPI: 1316187032
Provider Name (Legal Business Name): SUPPORTING BRIGHT STARS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2009
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 PAULS DR STE 200
BRANDON FL
33511-4716
US

IV. Provider business mailing address

330 PAULS DR STE 200
BRANDON FL
33511-4716
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-4166
  • Fax: 813-655-4814
Mailing address:
  • Phone: 813-655-4166
  • Fax: 813-655-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YEZENIA GONZALEZ
Title or Position: OWNER
Credential:
Phone: 813-655-4166