Provider Demographics
NPI:1215619101
Name:SATTERFIELD, KEVINA SHANELLE
Entity type:Individual
Prefix:MS
First Name:KEVINA
Middle Name:SHANELLE
Last Name:SATTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VITALIZE
Other - Middle Name:
Other - Last Name:AMBIANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ITDS
Mailing Address - Street 1:2234 LAKE WORTH RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3200
Mailing Address - Country:US
Mailing Address - Phone:561-298-4985
Mailing Address - Fax:
Practice Address - Street 1:2234 LAKE WORTH RD APT 101
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3200
Practice Address - Country:US
Practice Address - Phone:561-298-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2024-04-24
Deactivation Date:2023-08-01
Deactivation Code:
Reactivation Date:2024-03-25
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X, 174400000X, 246RP1900X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No374J00000XNursing Service Related ProvidersDoula
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy