Provider Demographics
NPI:1447766092
Name:MASTERS, DELSHAVEON
Entity Type:Individual
Prefix:
First Name:DELSHAVEON
Middle Name:
Last Name:MASTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 W T C JESTER BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-7035
Mailing Address - Country:US
Mailing Address - Phone:832-228-8242
Mailing Address - Fax:
Practice Address - Street 1:2802 W TC JESTER BLVD
Practice Address - Street 2:APT 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018
Practice Address - Country:US
Practice Address - Phone:713-256-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist