Healthcare Provider Details

I. General information

NPI: 1023996485
Provider Name (Legal Business Name): LATONYA SHAY MCNEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S 3RD ST
LOUISVILLE KY
40203-2215
US

IV. Provider business mailing address

901 SOUTHWESTERN PKWY
LOUISVILLE KY
40211-2743
US

V. Phone/Fax

Practice location:
  • Phone: 502-830-7367
  • Fax:
Mailing address:
  • Phone: 502-356-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: