Provider Demographics
NPI:1376085258
Name:GULLETTE, SHAWON LYNN (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:SHAWON
Middle Name:LYNN
Last Name:GULLETTE
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2382
Mailing Address - Country:US
Mailing Address - Phone:937-281-0555
Mailing Address - Fax:
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2382
Practice Address - Country:US
Practice Address - Phone:937-281-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management