Provider Demographics
NPI:1457853897
Name:STALHUT, SHANNON LEKNISKAS
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEKNISKAS
Last Name:STALHUT
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 1:965 23RD PL SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-8120
Mailing Address - Country:US
Mailing Address - Phone:772-501-3558
Mailing Address - Fax:
Practice Address - Street 1:965 23RD PL SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-8120
Practice Address - Country:US
Practice Address - Phone:772-501-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other