Healthcare Provider Details

I. General information

NPI: 1730007576
Provider Name (Legal Business Name): BRIGHTSHIELD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 W VINE ST STE 109
KISSIMMEE FL
34741-4523
US

IV. Provider business mailing address

4139 W VINE ST STE 109
KISSIMMEE FL
34741-4523
US

V. Phone/Fax

Practice location:
  • Phone: 757-987-5868
  • Fax:
Mailing address:
  • Phone: 757-987-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: PATRICK S STANLEY
Title or Position: MANAGER
Credential:
Phone: 757-987-5868