MEDICARE: LASHONDA BURT-REEDER

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942766449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHONDA BURT-REEDER

Provider Business Mailing Address
First Line	:	622B OLD EASLEY HWY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-6521
Country	:	US
Telephone Number	:	864-910-0892
Fax Number	:

Provider Business Practice Location Address
First Line	:	622B OLD EASLEY HWY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-6521
Country	:	US
Telephone Number	:	864-910-0892
Fax Number	:

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

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	08/12/2020

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