Provider Demographics
NPI:1023515079
Name:LEE, SHAUNTE NICOLE
Entity type:Individual
Prefix:
First Name:SHAUNTE
Middle Name:NICOLE
Last Name:LEE
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 1:5519 LANIER AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-6267
Mailing Address - Country:US
Mailing Address - Phone:202-779-5997
Mailing Address - Fax:
Practice Address - Street 1:5519 LANIER AVE
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-6267
Practice Address - Country:US
Practice Address - Phone:202-779-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant