Provider Demographics
NPI:1376281006
Name:LAKATOS, SHANE SMITH
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:SMITH
Last Name:LAKATOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2063
Mailing Address - Country:US
Mailing Address - Phone:419-704-2314
Mailing Address - Fax:
Practice Address - Street 1:5632 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2063
Practice Address - Country:US
Practice Address - Phone:419-704-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant