Provider Demographics
NPI:1356000244
Name:SHEFTALL, LAUREN
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:SHEFTALL
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 1:10616 MELLOW MDWS APT 22A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1215
Mailing Address - Country:US
Mailing Address - Phone:512-412-8146
Mailing Address - Fax:
Practice Address - Street 1:10616 MELLOW MDWS APT 22A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1215
Practice Address - Country:US
Practice Address - Phone:512-762-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist