Healthcare Provider Details

I. General information

NPI: 1093443566
Provider Name (Legal Business Name): SHINING LIGHT THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BISCAYNE BLVD APT 708
MIAMI FL
33137-4566
US

IV. Provider business mailing address

2500 BISCAYNE BLVD APT 708
MIAMI FL
33137-4566
US

V. Phone/Fax

Practice location:
  • Phone: 954-300-2873
  • Fax:
Mailing address:
  • Phone: 786-202-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENILEE M ESTEVEZ
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: OTR/L
Phone: 786-202-8366