Provider Demographics
NPI:1326192881
Name:LILLYWHITE, SHAUNA RENEE (LMT)
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:RENEE
Last Name:LILLYWHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SE 73RD TERR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641
Mailing Address - Country:US
Mailing Address - Phone:352-374-8532
Mailing Address - Fax:
Practice Address - Street 1:4820 NEWBERRY ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609
Practice Address - Country:US
Practice Address - Phone:352-373-2116
Practice Address - Fax:352-373-1507
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
106774Medicare ID - Type Unspecified