Provider Demographics
NPI:1831773969
Name:LINDSEY, SHAVONDA
Entity type:Individual
Prefix:
First Name:SHAVONDA
Middle Name:
Last Name:LINDSEY
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 1:1138 CHASE PARK DR
Mailing Address - Street 2:
Mailing Address - City:BACLIFF
Mailing Address - State:TX
Mailing Address - Zip Code:77518-2485
Mailing Address - Country:US
Mailing Address - Phone:409-256-4172
Mailing Address - Fax:
Practice Address - Street 1:1138 CHASE PARK DR
Practice Address - Street 2:
Practice Address - City:BACLIFF
Practice Address - State:TX
Practice Address - Zip Code:77518-2485
Practice Address - Country:US
Practice Address - Phone:409-256-4172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion