Provider Demographics
NPI:1689703928
Name:LUMPKIN, LASHANDA KAYON (BA)
Entity Type:Individual
Prefix:
First Name:LASHANDA
Middle Name:KAYON
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LASHANDA
Other - Middle Name:KAYON
Other - Last Name:LUMPKIN HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9800 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3071
Mailing Address - Country:US
Mailing Address - Phone:954-677-3113
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:2900 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2519
Practice Address - Country:US
Practice Address - Phone:954-677-3113
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762083700Medicaid