Provider Demographics
NPI:1346009503
Name:JEFFERSON, DESHONDA LASHAY
Entity Type:Individual
Prefix:
First Name:DESHONDA
Middle Name:LASHAY
Last Name:JEFFERSON
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 1:6430 MAPLEDOWNS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-3935
Mailing Address - Country:US
Mailing Address - Phone:260-582-1836
Mailing Address - Fax:
Practice Address - Street 1:6430 MAPLEDOWNS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3935
Practice Address - Country:US
Practice Address - Phone:260-582-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker