Provider Demographics
NPI:1518634104
Name:SHINE BEHAVIOR THERAPY INC
Entity Type:Organization
Organization Name:SHINE BEHAVIOR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA 1-20-42701
Authorized Official - Phone:786-312-4478
Mailing Address - Street 1:1670 EGRET RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1080
Mailing Address - Country:US
Mailing Address - Phone:786-312-4478
Mailing Address - Fax:
Practice Address - Street 1:1670 EGRET RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1080
Practice Address - Country:US
Practice Address - Phone:786-312-4478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty