Provider Demographics
NPI:1326910027
Name:MCKENZIE, MAJESTY-SHANTWAN MINNI-RUTH
Entity type:Individual
Prefix:
First Name:MAJESTY-SHANTWAN
Middle Name:MINNI-RUTH
Last Name:MCKENZIE
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 1:970 SOUTHLAKES WAY SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-7526
Mailing Address - Country:US
Mailing Address - Phone:772-696-0953
Mailing Address - Fax:
Practice Address - Street 1:970 SOUTHLAKES WAY SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-7526
Practice Address - Country:US
Practice Address - Phone:772-696-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3950246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy