Provider Demographics
NPI:1922449966
Name:KNIGHT, DESHAZOR M
Entity Type:Individual
Prefix:
First Name:DESHAZOR
Middle Name:M
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16350 BRUCE B DOWNS BLVD
Mailing Address - Street 2:#48522
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-9001
Mailing Address - Country:US
Mailing Address - Phone:813-638-1073
Mailing Address - Fax:
Practice Address - Street 1:823 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1808
Practice Address - Country:US
Practice Address - Phone:407-347-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator