Provider Demographics
NPI:1013660422
Name:WASHINGTON, SHAMONE LANIECE
Entity Type:Individual
Prefix:
First Name:SHAMONE
Middle Name:LANIECE
Last Name:WASHINGTON
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 1:405 OAK ST APT B
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-4703
Mailing Address - Country:US
Mailing Address - Phone:205-613-1792
Mailing Address - Fax:
Practice Address - Street 1:405 OAK ST APT B
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-4703
Practice Address - Country:US
Practice Address - Phone:205-613-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer