Provider Demographics
NPI:1487226403
Name:DE VEAUX, SHIKINA LATRICE (SPECIALIST)
Entity type:Individual
Prefix:MRS
First Name:SHIKINA
Middle Name:LATRICE
Last Name:DE VEAUX
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 LAVISTA RD APT 3
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5675
Mailing Address - Country:US
Mailing Address - Phone:334-444-0069
Mailing Address - Fax:
Practice Address - Street 1:3791 LAVISTA RD APT 3
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5675
Practice Address - Country:US
Practice Address - Phone:334-444-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1346951744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management