Healthcare Provider Details

I. General information

NPI: 1295083137
Provider Name (Legal Business Name): SHAWNDOLYN KENYITTA LEBINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 BERTRAND DR
LAFAYETTE LA
70506-5556
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 337-294-1230
  • Fax: 833-749-0347
Mailing address:
  • Phone: 407-533-6836
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07033
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: