Provider Demographics
NPI:1881402691
Name:SPEED, KIARA LATICIA SHARRELLE (MEDICAL ASSISTANT CN)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:LATICIA SHARRELLE
Last Name:SPEED
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 IOWA STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-523-8964
Mailing Address - Fax:
Practice Address - Street 1:745 IOWA STREET
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-523-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLK2M9A8P2390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program