Provider Demographics
NPI:1275951675
Name:LASHLEY, DEANA KAY (DO)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:KAY
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4738
Mailing Address - Country:US
Mailing Address - Phone:904-633-0338
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR STE 1130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8331
Practice Address - Country:US
Practice Address - Phone:904-633-0190
Practice Address - Fax:904-633-0191
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064725208000000X
FL14911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics