Healthcare Provider Details

I. General information

NPI: 1538091376
Provider Name (Legal Business Name): NAKIA SHEVETTE JOHNSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 MERRICK RD
MASSAPEQUA NY
11758-6215
US

IV. Provider business mailing address

20826 GRAND CENTRAL PKWY APT 2C
QUEENS VILLAGE NY
11427-1560
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-8933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: