Provider Demographics
NPI:1558067496
Name:PARADIGM SHIFT LLC
Entity Type:Organization
Organization Name:PARADIGM SHIFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:703-789-5609
Mailing Address - Street 1:41844 RAWNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8040
Mailing Address - Country:US
Mailing Address - Phone:703-789-5609
Mailing Address - Fax:
Practice Address - Street 1:44031 PIPELINE PLZ STE 301
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5888
Practice Address - Country:US
Practice Address - Phone:703-789-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health