MEDICARE: KENYA SHINE

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	207256	OK

General Provider Information

NPI Number	:	1649129610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA SHINE

Provider Business Mailing Address
First Line	:	3358 DEL AIRE PL
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4806
Country	:	US
Telephone Number	:	405-882-7204
Fax Number	:

Provider Business Practice Location Address
First Line	:	3358 DEL AIRE PL
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4806
Country	:	US
Telephone Number	:	405-882-7204
Fax Number	:

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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Directions to “ KENYA SHINE ” Practice Location

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