Provider Demographics
NPI:1063933190
Name:SAWYER-CASSIDY, SHELEMA M (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SHELEMA
Middle Name:M
Last Name:SAWYER-CASSIDY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:SHELEMA
Other - Middle Name:M
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:29 S FAYETTEVILLE ST STE 409
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-9006
Mailing Address - Country:US
Mailing Address - Phone:910-835-9096
Mailing Address - Fax:
Practice Address - Street 1:3404 DAVIS ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-3214
Practice Address - Country:US
Practice Address - Phone:910-835-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist