Provider Demographics
NPI:1447518618
Name:LINDSAY, SHANTA JANERNITA (CHA1)
Entity type:Individual
Prefix:
First Name:SHANTA
Middle Name:JANERNITA
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:CHA1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SAFEWAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056
Mailing Address - Country:US
Mailing Address - Phone:704-923-3079
Mailing Address - Fax:
Practice Address - Street 1:1140 SAFEWAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056
Practice Address - Country:US
Practice Address - Phone:704-923-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC315905367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered