Provider Demographics
NPI:1477044584
Name:JENKINS, SHAHEDA DANIELLE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:SHAHEDA
Middle Name:DANIELLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17160 MEYERS RD APT 47
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1418
Mailing Address - Country:US
Mailing Address - Phone:313-246-7262
Mailing Address - Fax:
Practice Address - Street 1:17160 MEYERS RD APT 47
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1418
Practice Address - Country:US
Practice Address - Phone:313-246-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty