Provider Demographics
NPI:1326604778
Name:JOHNSON, SHALONDA RENEE' (CPT, CPI)
Entity Type:Individual
Prefix:MRS
First Name:SHALONDA
Middle Name:RENEE'
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPT, CPI
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5600 NW CENTRAL DR STE 280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2065
Mailing Address - Country:US
Mailing Address - Phone:346-255-2192
Mailing Address - Fax:832-201-7383
Practice Address - Street 1:20751 CYPRESS CRESCENT LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6513
Practice Address - Country:US
Practice Address - Phone:832-983-1866
Practice Address - Fax:844-544-4514
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory