MEDICARE: DESHALA S ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1629883020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHALA S ROBINSON

Provider Business Mailing Address
First Line	:	1138 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3903
Country	:	US
Telephone Number	:	863-333-5303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3903
Country	:	US
Telephone Number	:	863-333-5303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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Directions to “ DESHALA S ROBINSON ” Practice Location

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