Provider Demographics
NPI:1841757648
Name:MISSICK/SEYMOUR, SHEMIKA NATASHA
Entity Type:Individual
Prefix:
First Name:SHEMIKA
Middle Name:NATASHA
Last Name:MISSICK/SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEMIKA
Other - Middle Name:
Other - Last Name:SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1418 AVON LN APT 27
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5894
Mailing Address - Country:US
Mailing Address - Phone:754-273-0789
Mailing Address - Fax:954-366-6099
Practice Address - Street 1:1418 AVON LN APT 27
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5894
Practice Address - Country:US
Practice Address - Phone:754-273-0789
Practice Address - Fax:954-366-6099
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234839376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker