MEDICARE: SHEMIKIA BANKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019018315	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T60558827	OTHER	VA	DRIVER LICENSE

General Provider Information

NPI Number	:	1083336119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEMIKIA BANKS

Provider Business Mailing Address
First Line	:	809 E OCEAN VIEW AVE # 209
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-1822
Country	:	US
Telephone Number	:	757-909-7986
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 E OCEAN VIEW AVE # 209
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-1822
Country	:	US
Telephone Number	:	757-909-7986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	03/30/2023

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Directions to “ SHEMIKIA BANKS ” Practice Location

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