Provider Demographics
NPI:1003125220
Name:LEE, SHATOYA ASHLEE
Entity Type:Individual
Prefix:MISS
First Name:SHATOYA
Middle Name:ASHLEE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PONDVIEW DR
Mailing Address - Street 2:APT. 14
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-6807
Mailing Address - Country:US
Mailing Address - Phone:516-610-7583
Mailing Address - Fax:
Practice Address - Street 1:8 PONDVIEW DR
Practice Address - Street 2:APT. 14
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-6807
Practice Address - Country:US
Practice Address - Phone:516-610-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302652-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse