Provider Demographics
NPI:1265999452
Name:GRENADE-SHOEMAKER, LAKEISHA (CLC)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:GRENADE-SHOEMAKER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 BLAKELEY RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9778
Mailing Address - Country:US
Mailing Address - Phone:716-712-4236
Mailing Address - Fax:
Practice Address - Street 1:2077 BLAKELEY RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9778
Practice Address - Country:US
Practice Address - Phone:716-712-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYALPP-310006174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN