Provider Demographics
NPI:1194210286
Name:STACHURA-LEE, LATASHIA
Entity Type:Individual
Prefix:MISS
First Name:LATASHIA
Middle Name:
Last Name:STACHURA-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 1:612 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2504
Mailing Address - Country:US
Mailing Address - Phone:716-377-3687
Mailing Address - Fax:
Practice Address - Street 1:612 23RD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2504
Practice Address - Country:US
Practice Address - Phone:716-377-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336106651344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi