Provider Demographics
NPI:1255775862
Name:SHINING STARS SPEECH AND LANGUAGE THERAPY CORP.
Entity type:Organization
Organization Name:SHINING STARS SPEECH AND LANGUAGE THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-801-9365
Mailing Address - Street 1:9601 SW 142ND AVE
Mailing Address - Street 2:611
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7327
Mailing Address - Country:US
Mailing Address - Phone:305-801-9365
Mailing Address - Fax:
Practice Address - Street 1:9601 SW 142ND AVE
Practice Address - Street 2:611
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7327
Practice Address - Country:US
Practice Address - Phone:305-801-9365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty