Provider Demographics
NPI:1134881790
Name:LASHLEY, GARY SHANE
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:SHANE
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 CHAPEL HILL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8401
Mailing Address - Country:US
Mailing Address - Phone:972-378-0120
Mailing Address - Fax:
Practice Address - Street 1:6101 CHAPEL HILL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8401
Practice Address - Country:US
Practice Address - Phone:972-378-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program