Provider Demographics
NPI:1508436510
Name:PENNIX, LASHONIA SHASHERAH
Entity type:Individual
Prefix:
First Name:LASHONIA
Middle Name:SHASHERAH
Last Name:PENNIX
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 1:3015 N SCOTTSDALE RD UNIT 4222
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7262
Mailing Address - Country:US
Mailing Address - Phone:480-840-4351
Mailing Address - Fax:
Practice Address - Street 1:1616 E INDIAN SCHOOL RD STE 350
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8603
Practice Address - Country:US
Practice Address - Phone:480-840-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health