MEDICARE: MS. LASHELLE SHONETTE HENDERSON MSN,FNP-BC,PMHNP-BC

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
1	163WG0000X	General Practice Registered Nurse	RN.303252	OH
2	363LF0000X	Family Nurse Practitioner	2012017792	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2019076475	OH

General Provider Information

NPI Number	:	1831302264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASHELLE SHONETTE HENDERSON MSN,FNP-BC,PMHNP-BC

Provider Business Mailing Address
First Line	:	5241 WILSON MILLS RD # 35C
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2150
Country	:	US
Telephone Number	:	440-221-2449
Fax Number	:	440-448-4912

Provider Business Practice Location Address
First Line	:	150 CROSS ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1026
Country	:	US
Telephone Number	:	330-996-9141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	01/30/2024

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