Provider Demographics
NPI:1821608365
Name:HEARD, DEADRA M
Entity Type:Individual
Prefix:
First Name:DEADRA
Middle Name:M
Last Name:HEARD
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 1:439 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1510
Mailing Address - Country:US
Mailing Address - Phone:510-253-7311
Mailing Address - Fax:
Practice Address - Street 1:439 SPARROW DR
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1510
Practice Address - Country:US
Practice Address - Phone:510-253-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist