Provider Demographics
NPI:1720469711
Name:KNIGHT, SHALONDA
Entity Type:Individual
Prefix:MS
First Name:SHALONDA
Middle Name:
Last Name:KNIGHT
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 1:2253 MEAGAN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39272-5682
Mailing Address - Country:US
Mailing Address - Phone:662-721-6970
Mailing Address - Fax:
Practice Address - Street 1:6204 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-9731
Practice Address - Country:US
Practice Address - Phone:601-321-9653
Practice Address - Fax:769-233-8094
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist