Healthcare Provider Details

I. General information

NPI: 1659986230
Provider Name (Legal Business Name): MISS CHIEDZA MASHAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SALISBURY RD STE 400
JACKSONVILLE FL
32256-6187
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 954-271-3124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: