Provider Demographics
NPI:1083336119
Name:BANKS, SHEMIKIA
Entity Type:Individual
Prefix:
First Name:SHEMIKIA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E OCEAN VIEW AVE # 209
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1822
Mailing Address - Country:US
Mailing Address - Phone:757-909-7986
Mailing Address - Fax:
Practice Address - Street 1:809 E OCEAN VIEW AVE # 209
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-1822
Practice Address - Country:US
Practice Address - Phone:757-909-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT60558827OtherDRIVER LICENSE