Provider Demographics
NPI:1235671983
Name:LEE, SHAWN WILLIAM I
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:WILLIAM
Last Name:LEE
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SHAWN
Other - Middle Name:WILIAM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 W CHURCH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-1277
Mailing Address - Country:US
Mailing Address - Phone:215-390-4215
Mailing Address - Fax:
Practice Address - Street 1:109 W CHURCH ST
Practice Address - Street 2:APT #2
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1277
Practice Address - Country:US
Practice Address - Phone:215-390-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer