Provider Demographics
NPI:1194489708
Name:LAURAY, KEYADA (MA91822)
Entity type:Individual
Prefix:
First Name:KEYADA
Middle Name:
Last Name:LAURAY
Suffix:
Gender:F
Credentials:MA91822
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9943 ROSEWOOD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-4331
Mailing Address - Country:US
Mailing Address - Phone:904-729-7924
Mailing Address - Fax:
Practice Address - Street 1:811 N MARKET ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:904-510-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA91822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist