Provider Demographics
NPI:1629462247
Name:SPEAKS, DEIYONNA SHANDRIKA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:DEIYONNA
Middle Name:SHANDRIKA
Last Name:SPEAKS
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:PO BOX 1545
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-1545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 WESTUBURY PARKWAY SUITE 102
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-0000
Practice Address - Country:US
Practice Address - Phone:843-734-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist