Provider Demographics
NPI:1508114521
Name:STARSHINE LLC
Entity Type:Organization
Organization Name:STARSHINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERACLEOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-1222
Mailing Address - Street 1:1902 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1113
Mailing Address - Country:US
Mailing Address - Phone:212-928-1222
Mailing Address - Fax:718-374-6109
Practice Address - Street 1:1902 42ND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1113
Practice Address - Country:US
Practice Address - Phone:212-928-1222
Practice Address - Fax:718-374-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty