Provider Demographics
NPI:1083148449
Name:DESHAZER, MASHANDA (CNA,CMA,RMA,RP,LVNRN)
Entity Type:Individual
Prefix:
First Name:MASHANDA
Middle Name:
Last Name:DESHAZER
Suffix:
Gender:F
Credentials:CNA,CMA,RMA,RP,LVNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 T C JESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-7458
Mailing Address - Country:US
Mailing Address - Phone:832-654-0396
Mailing Address - Fax:832-288-4192
Practice Address - Street 1:10807 MISTY RIVER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-1919
Practice Address - Country:US
Practice Address - Phone:214-277-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376G00000X
OKNA0010075140376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty