Provider Demographics
NPI:1619725546
Name:LEE, SHANNELLE (LPN)
Entity type:Individual
Prefix:
First Name:SHANNELLE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANNELLE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHANNELLE LEE LPN
Mailing Address - Street 1:1525 STRATFORD AVE OFC
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-1434
Mailing Address - Country:US
Mailing Address - Phone:203-257-8700
Mailing Address - Fax:203-257-8701
Practice Address - Street 1:1525 STRATFORD AVE OFC
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06607-1434
Practice Address - Country:US
Practice Address - Phone:203-257-8700
Practice Address - Fax:203-257-8701
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002289251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health