Provider Demographics
NPI:1437933066
Name:BREAZELL, LASHANYA JEANEAN
Entity Type:Individual
Prefix:
First Name:LASHANYA
Middle Name:JEANEAN
Last Name:BREAZELL
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 1:1809 S ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6760
Mailing Address - Country:US
Mailing Address - Phone:800-707-3358
Mailing Address - Fax:
Practice Address - Street 1:3701 POWER INN RD STE 3100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4351
Practice Address - Country:US
Practice Address - Phone:800-707-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374J00000XNursing Service Related ProvidersDoula
No175T00000XOther Service ProvidersPeer Specialist