Provider Demographics
NPI:1154902468
Name:DESANDO, SHAYNA LEE (DO)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:LEE
Last Name:DESANDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 GAILLARDIA WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6703
Mailing Address - Country:US
Mailing Address - Phone:860-839-9223
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST SCHOOL OF MEDICINE MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4311
Practice Address - Fax:336-716-7595
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program