Provider Demographics
NPI:1306411152
Name:LANHAM, SHELBY LEIGH
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LEIGH
Last Name:LANHAM
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 1:1672 ROBIN PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5151
Mailing Address - Country:US
Mailing Address - Phone:615-598-5935
Mailing Address - Fax:
Practice Address - Street 1:1489 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3875
Practice Address - Country:US
Practice Address - Phone:931-553-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program