Healthcare Provider Details

I. General information

NPI: 1750213963
Provider Name (Legal Business Name): KENTOIYA MONISH DESHAZER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CITI CTR ST # 1024
WINTER HAVEN FL
33880-3425
US

IV. Provider business mailing address

470 CITI CTR ST # 1024
WINTER HAVEN FL
33880-3425
US

V. Phone/Fax

Practice location:
  • Phone: 321-429-6009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9479150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: