Provider Demographics
NPI:1326774423
Name:LAZARRE, SHANTERRIA L (BS, MHA)
Entity Type:Individual
Prefix:
First Name:SHANTERRIA
Middle Name:L
Last Name:LAZARRE
Suffix:
Gender:F
Credentials:BS, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 APOPKA BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7622
Mailing Address - Country:US
Mailing Address - Phone:407-884-2125
Mailing Address - Fax:
Practice Address - Street 1:1991 APOPKA BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7622
Practice Address - Country:US
Practice Address - Phone:407-884-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL658870Medicaid