Provider Demographics
NPI:1508530320
Name:LEE, SHAKEITHDRA (RN)
Entity Type:Individual
Prefix:MS
First Name:SHAKEITHDRA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 GREEN TREE LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3612
Mailing Address - Country:US
Mailing Address - Phone:281-630-2328
Mailing Address - Fax:
Practice Address - Street 1:1810 GREEN TREE LN
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3612
Practice Address - Country:US
Practice Address - Phone:281-630-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX899799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse