Provider Demographics
NPI:1154955201
Name:ADKISON, SHAYNA CHRISTINE
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:CHRISTINE
Last Name:ADKISON
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 1:2961 S ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-6501
Mailing Address - Country:US
Mailing Address - Phone:702-370-6268
Mailing Address - Fax:
Practice Address - Street 1:452 W FINNIE FLAT RD STE M
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7298
Practice Address - Country:US
Practice Address - Phone:702-370-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty