Healthcare Provider Details

I. General information

NPI: 1063402998
Provider Name (Legal Business Name): SHANTAE LADON LUCAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 BREVARD RD
ASHEVILLE NC
28806-2316
US

IV. Provider business mailing address

28 BRADDOCK WAY
ASHEVILLE NC
28803-2026
US

V. Phone/Fax

Practice location:
  • Phone: 828-212-7021
  • Fax:
Mailing address:
  • Phone: 828-277-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number9800619
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9800619
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number9800619
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: