Provider Demographics
NPI:1417829920
Name:SHINING STAR CLINIC LLC
Entity type:Organization
Organization Name:SHINING STAR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZESHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-969-4214
Mailing Address - Street 1:8121 GEORGIA AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8121 GEORGIA AVE STE 450
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4962
Practice Address - Country:US
Practice Address - Phone:301-969-4214
Practice Address - Fax:301-969-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty