Provider Demographics
NPI:1740082734
Name:LYN, SHAQUENA (MAT)
Entity type:Individual
Prefix:
First Name:SHAQUENA
Middle Name:
Last Name:LYN
Suffix:
Gender:
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 SPICY CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7160
Mailing Address - Country:US
Mailing Address - Phone:678-989-6208
Mailing Address - Fax:
Practice Address - Street 1:3153 SPICY CEDAR LN
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-7160
Practice Address - Country:US
Practice Address - Phone:678-989-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty