Provider Demographics
NPI:1053033514
Name:WARD-KING, SHAHEDRA
Entity type:Individual
Prefix:
First Name:SHAHEDRA
Middle Name:
Last Name:WARD-KING
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 1:3350 SE US HIGHWAY 41 UNIT 473
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-3352
Mailing Address - Country:US
Mailing Address - Phone:845-633-3466
Mailing Address - Fax:
Practice Address - Street 1:582 SE 7TH AVE STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4840
Practice Address - Country:US
Practice Address - Phone:352-228-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health