Provider Demographics
NPI:1417658501
Name:VAULT, LASHANDUA MICHELLE
Entity Type:Individual
Prefix:
First Name:LASHANDUA
Middle Name:MICHELLE
Last Name:VAULT
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 1:825 RIDGE LANE DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-6055
Mailing Address - Country:US
Mailing Address - Phone:205-370-7299
Mailing Address - Fax:
Practice Address - Street 1:4260 CAHABA HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5711
Practice Address - Country:US
Practice Address - Phone:205-370-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide