Shiningstar Independent LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

SHININGSTAR INDEPENDENT LLC

Practice address

5146 N 11TH Ave Apt D208
Phoenix, AZ 85013-2161

Phone

(240) 374-2292

NPI assigned

Apr 20, 2020

Organization subpart

No

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

Authorized official

Name

Lucia Olufunmilayo Ajayi

Title

Ceo

Phone

(240) 374-2292

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1336769322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5146 N 11TH AVE APT D208",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850132161",
            "telephone_number": "240-374-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5146 N 11TH AVE APT D208",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850132161",
            "telephone_number": "240-374-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHININGSTAR INDEPENDENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "AJAYI",
        "authorized_official_first_name": "LUCIA",
        "authorized_official_middle_name": "OLUFUNMILAYO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-374-2292"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ron Z Shinar, MD
• Richard L. Shindell, M.D.
• Shine Dental Arts PLLC
• Peggy Shingleton
• Shining New Light LLC
• Jessica Juleen Shinkle Williams
• Shelby Tate Shinn, RN
• Eliezer Shinnar
• Marlene Shiple, PH.D.
• Laura Eileen Shipley, M.S., CCC-SLP

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; 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.