Provider Demographics
NPI:1548224363
Name:SHADOAN, LYNNETTE L
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:L
Last Name:SHADOAN
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 1:2811 LINKHORNE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3321
Mailing Address - Country:US
Mailing Address - Phone:434-384-1594
Mailing Address - Fax:
Practice Address - Street 1:2811 LINKHORNE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3321
Practice Address - Country:US
Practice Address - Phone:434-384-1594
Practice Address - Fax:434-384-3228
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002222101YP2500X
VA0717000385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA326051OtherANTHEM BC/BS