Provider Demographics
NPI:1679174957
Name:EVANS, SHASTA LASHEA
Entity Type:Individual
Prefix:
First Name:SHASTA
Middle Name:LASHEA
Last Name:EVANS
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 1:5916 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25306-6045
Mailing Address - Country:US
Mailing Address - Phone:304-553-3989
Mailing Address - Fax:
Practice Address - Street 1:5916 STARLING DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25306-6045
Practice Address - Country:US
Practice Address - Phone:304-553-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant