Provider Demographics
NPI:1013758804
Name:LALANNE, SHENIKA LAVETTE
Entity type:Individual
Prefix:
First Name:SHENIKA
Middle Name:LAVETTE
Last Name:LALANNE
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 1:1257 RUSTLING PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2261
Mailing Address - Country:US
Mailing Address - Phone:850-980-9794
Mailing Address - Fax:
Practice Address - Street 1:1257 RUSTLING PINES BLVD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-2261
Practice Address - Country:US
Practice Address - Phone:850-980-9794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist