Provider Demographics
NPI:1194309013
Name:LANE-FLEURINORD, SHANEECE (PSYD)
Entity type:Individual
Prefix:
First Name:SHANEECE
Middle Name:
Last Name:LANE-FLEURINORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NEECE
Other - Middle Name:
Other - Last Name:LANE-FLEURINORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2300 VALLEY ST APT 106
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2529
Mailing Address - Country:US
Mailing Address - Phone:813-409-0325
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST STE 259
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2940
Practice Address - Country:US
Practice Address - Phone:510-269-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor