Provider Demographics
NPI:1003541756
Name:LASHLEY, SHAVON J
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:J
Last Name:LASHLEY
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 1:2061 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8605
Mailing Address - Country:US
Mailing Address - Phone:973-855-9528
Mailing Address - Fax:
Practice Address - Street 1:2061 TUDOR DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8605
Practice Address - Country:US
Practice Address - Phone:973-855-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238093163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse