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NPI Code Detail

MEDICARE: SHASTA LASHAY DOUGLAS MSW

MEDICARE: SHASTA LASHAY DOUGLAS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerVA

General Provider Information

NPI Number : 1265309611
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHASTA LASHAY DOUGLAS MSW
Provider Business Mailing Address
First Line : 10904 HARPERS SQUARE CT
Second Line :
City : RESTON
State : VA
Zip : 20191-5011
Country : US
Telephone Number : 256-717-4095
Fax Number :
Provider Business Practice Location Address
First Line : 10300 EATON PL STE 440
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-2239
Country : US
Telephone Number : 256-717-4095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2025
Last Update Date : 10/21/2025

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