Provider Demographics
NPI:1750965679
Name:BERKLEY, SHAVIA
Entity type:Individual
Prefix:
First Name:SHAVIA
Middle Name:
Last Name:BERKLEY
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:PO BOX 421071
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-1071
Mailing Address - Country:US
Mailing Address - Phone:352-871-4613
Mailing Address - Fax:
Practice Address - Street 1:1802 CONCORD CIR APT H
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3464
Practice Address - Country:US
Practice Address - Phone:352-871-4613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide