Provider Demographics
NPI:1285093146
Name:LEE, SHIRLEY-ANN RENEE (ATC)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY-ANN
Middle Name:RENEE
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 K M WICKER MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5070
Mailing Address - Country:US
Mailing Address - Phone:919-708-5031
Mailing Address - Fax:919-718-0097
Practice Address - Street 1:1915 K M WICKER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5070
Practice Address - Country:US
Practice Address - Phone:919-708-5031
Practice Address - Fax:919-718-0097
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
070602002OtherBOC