Healthcare Provider Details

I. General information

NPI: 1902464407
Provider Name (Legal Business Name): SHENIQUA MARSHALL MASTER HERBALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GODIS AUSET REIKI MASTER

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 09/29/2026
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N LUMPKIN RD APT 4107
COLUMBUS GA
31903-6606
US

IV. Provider business mailing address

3390 N LUMPKIN RD APT 4107
COLUMBUS GA
31903-6606
US

V. Phone/Fax

Practice location:
  • Phone: 229-364-2721
  • Fax:
Mailing address:
  • Phone: 229-364-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: