Provider Demographics
NPI:1124715537
Name:SHINING STARS THERAPY LLC
Entity type:Organization
Organization Name:SHINING STARS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISHEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-665-8333
Mailing Address - Street 1:24741 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24741 CHURCH ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1982
Practice Address - Country:US
Practice Address - Phone:845-665-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech