Provider Demographics
NPI:1477164234
Name:KELLY, SHAMARAYA TRA'NECE (LMT)
Entity Type:Individual
Prefix:
First Name:SHAMARAYA
Middle Name:TRA'NECE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-1812
Mailing Address - Country:US
Mailing Address - Phone:407-694-4943
Mailing Address - Fax:
Practice Address - Street 1:614 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1812
Practice Address - Country:US
Practice Address - Phone:407-694-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA92417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist