Healthcare Provider Details

I. General information

NPI: 1831302264
Provider Name (Legal Business Name): LASHELLE SHONETTE HENDERSON MSN,FNP-BC,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CROSS ST
AKRON OH
44311-1026
US

IV. Provider business mailing address

5241 WILSON MILLS RD # 35C
RICHMOND HTS OH
44143-2150
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-9141
  • Fax:
Mailing address:
  • Phone: 440-221-2449
  • Fax: 440-448-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.303252
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012017792
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019076475
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: