Provider Demographics
NPI:1316291263
Name:MASON, KHRYSYS YOVANKA
Entity type:Individual
Prefix:MRS
First Name:KHRYSYS
Middle Name:YOVANKA
Last Name:MASON
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 1:5019 STONE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7362
Mailing Address - Country:US
Mailing Address - Phone:919-221-4327
Mailing Address - Fax:
Practice Address - Street 1:5019 STONE PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7362
Practice Address - Country:US
Practice Address - Phone:919-221-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist