Provider Demographics
NPI:1871901207
Name:SHELL, LASHAWNDA
Entity type:Individual
Prefix:
First Name:LASHAWNDA
Middle Name:
Last Name:SHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LASHAWNDA
Other - Middle Name:
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:76 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2162
Mailing Address - Country:US
Mailing Address - Phone:585-355-6624
Mailing Address - Fax:
Practice Address - Street 1:76 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2162
Practice Address - Country:US
Practice Address - Phone:585-355-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 313405164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse