MEDICARE: BRIGHT LIGHT CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1376493841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT LIGHT CONSULTING LLC

Provider Business Mailing Address
First Line	:	3021 LASALLE ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4448
Country	:	US
Telephone Number	:	704-833-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 LASALLE ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4448
Country	:	US
Telephone Number	:	704-833-8080
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM SPECIALIST
Name	:	SHAYLA T DAVIS
Credential	:
Telephone Number	:	980-418-7383

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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