KEAUNDRIA SHAQUILLE BROOMFIELD (NPI# 1215548391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215548391 |
| Entity Type | Individual |
| Full Name | KEAUNDRIA SHAQUILLE BROOMFIELD |
| Credential | MT |
| Practice Address |
116 Savannah Ave Statesboro GA 30458-4801 |
| Practice Telephone | 9122439200 |
| Practice Fax Number | 9122439207 |
| Mailing Telephone | 9122439200 |
| Mailing Fax Number | 9122439207 |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | MT012945 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
116 SAVANNAH AVE |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-4801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083110720 | Melissa Kate Dukquits | Dietitian, Registered | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2018-04-02 |
| 1609487784 | Kelsey Lauren Garner | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-12 |
| 1548871742 | Martha T Baynon | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-11 |
| 1669083960 | Emily A Andrychowski | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-11 |
| 1780206946 | Rian C Bush | Acupuncturist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-05-11 |
| 1093279952 | Acupuncture Angels LLC | Acupuncturist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2019-01-24 |
| 1154806735 | Julia Kathryn Gammon | Dietitian, Registered | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2018-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457829020 | Donald Devine | Massage Therapist | 502 Retriever Ct, Statesboro, GA 30461-4498 | 2018-11-13 |
| 1841471794 | Deborah Kay Stalcup | Massage Therapist | 1221 Merchant Way, Suit 101, Statesboro, GA 30458-0868 | 2007-11-20 |
| 1912198458 | Karla K. Swartz | Massage Therapist | 815 Gentilly Rd, Statesboro, GA 30458 | 2007-08-08 |
| 1609487784 | Kelsey Lauren Garner | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-12 |
| 1548871742 | Martha T Baynon | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-11 |
| 1669083960 | Emily A Andrychowski | Massage Therapist | 116 Savannah Ave, Statesboro, GA 30458-4801 | 2020-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396346169 | Debra Davis | Massage Therapist | 702 Baldwin Dr Ste A, Albany, GA 31707-4027 | 2020-11-06 |
| 1780285197 | Tyrone Roy | Massage Therapist | 869 King Rd, Stone Mountain, GA 30088-2203 | 2020-11-03 |
| 1295336758 | Nadia Elizabeth Jones | Massage Therapist | 300 S Hamilton St, Dalton, GA 30720-8215 | 2020-11-02 |
| 1164022968 | Gregory R Bell Jr. | Massage Therapist | 106 W Henry St # B, Savannah, GA 31401-6721 | 2020-10-30 |
| 1770183527 | Alexander Jones | Massage Therapist | 626 Dekalb Ave Se Apt 1445, Atlanta, GA 30312-5409 | 2020-10-30 |
| 1134728124 | Quaniessa Rochelle Jenkins | Massage Therapist | 449 Oak Dr # 2, Atlanta, GA 30354-1228 | 2020-10-20 |
| 1598364630 | Amy Yang | Massage Therapist | 4505 Bradstone Trce Nw, Lilburn, GA 30047-8019 | 2020-10-20 |
| 1073112405 | Tavia Rena Bell | Massage Therapist | 2512 Grayton Loop, Villa Rica, GA 30180-6702 | 2020-10-17 |
| 1063010437 | Miranda Browne | Massage Therapist | 335 Roberts Rd, Athens, GA 30606-1227 | 2020-10-16 |
| 1710585567 | Lailyn Pineda Burkett | Massage Therapist | 3550 Ga Highway 20 South, Conyers, GA 30013-2877 | 2020-10-14 |
| Find all providers with the same taxonomy | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.