Provider Demographics
NPI:1538788344
Name:SHELPMAN, DEANNA RENE (LMT)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:RENE
Last Name:SHELPMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15443 PLANTATION OAKS DR
Mailing Address - Street 2:APT 13
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:352-514-1139
Mailing Address - Fax:
Practice Address - Street 1:15443 PLANTATION OAKS DR
Practice Address - Street 2:APT 13
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:352-514-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA94387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist