Healthcare Provider Details

I. General information

NPI: 1558258970
Provider Name (Legal Business Name): RISE AND SHINE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 GRANDVIEW AVE
STATEN ISLAND NY
10303-1832
US

IV. Provider business mailing address

424 GRANDVIEW AVE
STATEN ISLAND NY
10303-1832
US

V. Phone/Fax

Practice location:
  • Phone: 929-460-9600
  • Fax: 646-330-4524
Mailing address:
  • Phone: 212-901-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAZIA KHALIQ
Title or Position: PRESIDENT
Credential:
Phone: 212-901-9922