Provider Demographics
NPI:1295083137
Name:LEBINE, SHAWNDOLYN KENYITTA (NP)
Entity type:Individual
Prefix:MRS
First Name:SHAWNDOLYN
Middle Name:KENYITTA
Last Name:LEBINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-533-6836
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:539 BERTRAND DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5556
Practice Address - Country:US
Practice Address - Phone:337-294-1230
Practice Address - Fax:833-749-0347
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2021-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP07033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317300Medicaid