Provider Demographics
NPI:1750802484
Name:WEBB, KIANA SAKURA
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:SAKURA
Last Name:WEBB
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 1:2520 GRASSY POINT DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6599
Mailing Address - Country:US
Mailing Address - Phone:407-330-8020
Mailing Address - Fax:
Practice Address - Street 1:2520 GRASSY POINT DR UNIT 202
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6599
Practice Address - Country:US
Practice Address - Phone:407-330-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program