Shining Star Healthcare Services Inc

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

SHINING STAR HEALTHCARE SERVICES INC

Practice address

16701 Melford Blvd Ste 400, Office # 452
Bowie, MD 20715

Phone

(410) 497-4917

NPI assigned

Feb 24, 2023

Organization subpart

No

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

Authorized official

Name

Yolande Fomenky

Title

Ceo

Phone

(410) 497-4917

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1346949666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16701 MELFORD BLVD STE 400",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207154305",
            "telephone_number": "410-497-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16701 MELFORD BLVD STE 400, OFFICE # 452",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "20715",
            "telephone_number": "410-497-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING STAR HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "FOMENKY",
        "authorized_official_first_name": "YOLANDE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-497-4917"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Bowie, MD
• Providers in Bowie, MD by specialty
• Developmental Disabilities Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.