Provider Demographics
NPI:1588437446
Name:UNDERWOOD, DEYJA DESHAWN
Entity type:Individual
Prefix:
First Name:DEYJA
Middle Name:DESHAWN
Last Name:UNDERWOOD
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:PO BOX 5824
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VIRGIN ISLANDS (VI)
Mailing Address - Zip Code:00823
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5030 ANCHOR WAY
Practice Address - Street 2:SUITE 9&10
Practice Address - City:CHRISTIANSTED
Practice Address - State:VIRGIN ISLANDS (VI)
Practice Address - Zip Code:00820
Practice Address - Country:UM
Practice Address - Phone:340-719-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-63166-1B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker