Provider Demographics
NPI:1205498698
Name:EVANS, SHEVONDA N (LMT)
Entity type:Individual
Prefix:
First Name:SHEVONDA
Middle Name:N
Last Name:EVANS
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 1:2 OFFICE PARK CT STE 102B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5948
Mailing Address - Country:US
Mailing Address - Phone:907-433-9529
Mailing Address - Fax:
Practice Address - Street 1:2 OFFICE PARK CT STE 102B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5948
Practice Address - Country:US
Practice Address - Phone:907-433-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty