=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083336119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEMIKIA BANKS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2022
-----------------------------------------------------
Last Update Date | 03/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 E OCEAN VIEW AVE # 209
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23503-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-909-7986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 E OCEAN VIEW AVE # 209
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23503-1822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-909-7986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 0019018315
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------