Provider Demographics
NPI:1356966949
Name:HUNTER, LAWONE SHANEL
Entity type:Individual
Prefix:
First Name:LAWONE
Middle Name:SHANEL
Last Name:HUNTER
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 1:2012 SEAGIRT BLVD APT 5F
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2827
Mailing Address - Country:US
Mailing Address - Phone:347-956-6220
Mailing Address - Fax:
Practice Address - Street 1:2012 SEAGIRT BLVD APT 5F
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2827
Practice Address - Country:US
Practice Address - Phone:347-956-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist