Provider Demographics
NPI:1578934915
Name:SHINE, LASHELL
Entity Type:Individual
Prefix:
First Name:LASHELL
Middle Name:
Last Name:SHINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LASHELL
Other - Middle Name:RE'NEE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3292 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7232
Mailing Address - Country:US
Mailing Address - Phone:863-494-4200
Mailing Address - Fax:863-494-4203
Practice Address - Street 1:201 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-4707
Practice Address - Country:US
Practice Address - Phone:863-494-4200
Practice Address - Fax:863-494-4203
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health