Provider Demographics
NPI:1306561055
Name:HANDT, LILY DEJAVU LE
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:DEJAVU LE
Last Name:HANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4213
Mailing Address - Country:US
Mailing Address - Phone:336-997-9395
Mailing Address - Fax:
Practice Address - Street 1:141 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4213
Practice Address - Country:US
Practice Address - Phone:336-997-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist