Healthcare Provider Details

I. General information

NPI: 1538995931
Provider Name (Legal Business Name): LETS SHINE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 NE 17TH AVE
CAPE CORAL FL
33909-2233
US

IV. Provider business mailing address

308 NE 17TH AVE
CAPE CORAL FL
33909-2233
US

V. Phone/Fax

Practice location:
  • Phone: 786-266-2920
  • Fax:
Mailing address:
  • Phone: 786-266-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JENNY HURTADO RIERA
Title or Position: MANAGER
Credential: BCBA
Phone: 786-266-2920