Provider Demographics
NPI:1831302264
Name:HENDERSON, LASHELLE SHONETTE (MSN,FNP-BC,PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LASHELLE
Middle Name:SHONETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSN,FNP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 WILSON MILLS RD # 35C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2150
Mailing Address - Country:US
Mailing Address - Phone:440-221-2449
Mailing Address - Fax:440-448-4912
Practice Address - Street 1:150 CROSS ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1026
Practice Address - Country:US
Practice Address - Phone:330-996-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.303252163WG0000X
OH2012017792363LF0000X
OH2019076475363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily