Provider Demographics
NPI:1225689557
Name:KING, LAKIA SHANNON
Entity Type:Individual
Prefix:
First Name:LAKIA
Middle Name:SHANNON
Last Name:KING
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 1:635 SHORT HILLS LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:635 SHORTHILLS LANE
Practice Address - Street 2:UNIT103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32905-3290
Practice Address - Country:US
Practice Address - Phone:860-573-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program