Provider Demographics
NPI:1801431200
Name:STUCKEY, LASHANA
Entity type:Individual
Prefix:MRS
First Name:LASHANA
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LASHANA
Other - Middle Name:
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3028 TRENT DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-7418
Mailing Address - Country:US
Mailing Address - Phone:843-409-8276
Mailing Address - Fax:
Practice Address - Street 1:3028 TRENT DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-7418
Practice Address - Country:US
Practice Address - Phone:843-409-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency