Provider Demographics
NPI:1710530431
Name:LASLEY, SHAWANNA F III
Entity Type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:F
Last Name:LASLEY
Suffix:III
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 1:4515 ALLISON ST STE 12191
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-9998
Mailing Address - Country:US
Mailing Address - Phone:513-817-1155
Mailing Address - Fax:
Practice Address - Street 1:1909 TRUITT AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1041
Practice Address - Country:US
Practice Address - Phone:513-817-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide