Healthcare Provider Details

I. General information

NPI: 1063332369
Provider Name (Legal Business Name): SHANTELL Q LAMARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22738 CYPRESSWOOD DR STE C
SPRING TX
77373-7121
US

IV. Provider business mailing address

22738 CYPRESSWOOD DR STE C
SPRING TX
77373-7121
US

V. Phone/Fax

Practice location:
  • Phone: 346-672-1184
  • Fax: 800-260-8791
Mailing address:
  • Phone: 346-672-1184
  • Fax: 800-260-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: