Provider Demographics
NPI:1770274441
Name:BRISCOE, LASHANTE M
Entity type:Individual
Prefix:
First Name:LASHANTE
Middle Name:M
Last Name:BRISCOE
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 1:2165 2ND AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2937
Mailing Address - Country:US
Mailing Address - Phone:813-843-9514
Mailing Address - Fax:
Practice Address - Street 1:2165 2ND AVE APT 2N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2937
Practice Address - Country:US
Practice Address - Phone:813-843-9514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1432795201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty