Shining Leaf Ipa, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SHINING LEAF IPA, LLC

Practice address

2900 Bragg St
Brooklyn, NY 11235-1144

Phone

(718) 268-4888

NPI assigned

Aug 8, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jeni Wallace

Title

Vice President of Operations

Phone

(718) 269-4888

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407456000000",
    "number": "1083023501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 BRAGG ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112351144",
            "telephone_number": "718-268-4888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 BRAGG ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112351144",
            "telephone_number": "718-268-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING LEAF IPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-08",
        "last_updated": "2014-08-08",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JENI",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "718-269-4888",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kseniya Shinkevich
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• Home Health Agency in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Home Health Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.