Provider Demographics
NPI:1871249060
Name:SHINE AND SHADOW, LLC
Entity type:Organization
Organization Name:SHINE AND SHADOW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KULKIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-909-2659
Mailing Address - Street 1:13 N WASHINGTON ST STE 155
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2617
Mailing Address - Country:US
Mailing Address - Phone:312-909-2659
Mailing Address - Fax:
Practice Address - Street 1:13 N WASHINGTON ST STE 155
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2617
Practice Address - Country:US
Practice Address - Phone:312-909-2659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty