Provider Demographics
NPI:1205523537
Name:MOLLICA, LASHONDA
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:MOLLICA
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 1:11601 KELTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1461
Mailing Address - Country:US
Mailing Address - Phone:216-254-2177
Mailing Address - Fax:
Practice Address - Street 1:11601 KELTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1461
Practice Address - Country:US
Practice Address - Phone:216-254-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator