Provider Demographics
NPI:1053907337
Name:KING, SHANKIYAH MARKISHA (CNA)
Entity type:Individual
Prefix:MISS
First Name:SHANKIYAH
Middle Name:MARKISHA
Last Name:KING
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S DOLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3005
Mailing Address - Country:US
Mailing Address - Phone:321-347-4264
Mailing Address - Fax:
Practice Address - Street 1:431 S DOLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3005
Practice Address - Country:US
Practice Address - Phone:321-347-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK520-793-95-725-0OtherIDENTIFICATION CARD