Provider Demographics
NPI:1841755220
Name:LAMBERT, SHAYAWNTAE A
Entity Type:Individual
Prefix:
First Name:SHAYAWNTAE
Middle Name:A
Last Name:LAMBERT
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 1:3310 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6511
Mailing Address - Country:US
Mailing Address - Phone:954-638-0604
Mailing Address - Fax:
Practice Address - Street 1:3310 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-6511
Practice Address - Country:US
Practice Address - Phone:954-638-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4374Medicaid
FL4374OtherPRIVATE INSURANCE CARRIER