Healthcare Provider Details

I. General information

NPI: 1215843057
Provider Name (Legal Business Name): SHINING GEM ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE STE 212
HIALEAH FL
33015-3670
US

IV. Provider business mailing address

17670 NW 78TH AVE STE 212
HIALEAH FL
33015-3670
US

V. Phone/Fax

Practice location:
  • Phone: 305-510-2283
  • Fax:
Mailing address:
  • Phone: 305-510-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: PEDRO PEREZ
Title or Position: ADMIN
Credential:
Phone: 305-510-2283