Provider Demographics
NPI:1346514478
Name:SHONE, SEBLEWONGEL NEGA (LSA/CSA)
Entity Type:Individual
Prefix:
First Name:SEBLEWONGEL
Middle Name:NEGA
Last Name:SHONE
Suffix:
Gender:F
Credentials:LSA/CSA
Other - Prefix:
Other - First Name:SEBLEWONGEL
Other - Middle Name:NEGA
Other - Last Name:SHONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSA/CSA
Mailing Address - Street 1:8303 SAND CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1065
Mailing Address - Country:US
Mailing Address - Phone:757-769-6157
Mailing Address - Fax:
Practice Address - Street 1:8303 SAND CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1065
Practice Address - Country:US
Practice Address - Phone:757-769-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0202246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant