Provider Demographics
NPI:1669070975
Name:ROBINSON, LELASANTA M
Entity type:Individual
Prefix:
First Name:LELASANTA
Middle Name:M
Last Name:ROBINSON
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 1:4991 COLONIAL PARK DR APT F
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2042
Mailing Address - Country:US
Mailing Address - Phone:304-356-6002
Mailing Address - Fax:
Practice Address - Street 1:4991 COLONIAL PARK DR APT F
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-2042
Practice Address - Country:US
Practice Address - Phone:304-356-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant