Provider Demographics
NPI:1902784382
Name:ROBERTS, NADIA SHAQUICE (LMT)
Entity type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:SHAQUICE
Last Name:ROBERTS
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 1:16065 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-5982
Mailing Address - Country:US
Mailing Address - Phone:850-339-1082
Mailing Address - Fax:
Practice Address - Street 1:16065 S US HIGHWAY 441 STE 103
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-5982
Practice Address - Country:US
Practice Address - Phone:850-339-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA103036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist