Provider Demographics
NPI:1336708486
Name:FLOYD, KENYATTA DE'ANA
Entity Type:Individual
Prefix:
First Name:KENYATTA
Middle Name:DE'ANA
Last Name:FLOYD
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 1:10739 ROCKLEDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2365
Mailing Address - Country:US
Mailing Address - Phone:470-230-5005
Mailing Address - Fax:
Practice Address - Street 1:10739 ROCKLEDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2365
Practice Address - Country:US
Practice Address - Phone:470-230-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide