MEDICARE: SHINING LYTES INC.

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1639922677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINING LYTES INC.

Provider Business Mailing Address
First Line	:	10001 DEREKWOOD LN STE 204
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10001 DEREKWOOD LN STE 204
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4864
Country	:	US
Telephone Number	:	301-377-1863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FLOYD E. LYTES II
Credential	:
Telephone Number	:	301-377-1863

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/09/2024

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