Provider Demographics
NPI:1972077873
Name:LASAINE, SHAELISA (CPE)
Entity type:Individual
Prefix:
First Name:SHAELISA
Middle Name:
Last Name:LASAINE
Suffix:
Gender:F
Credentials:CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547722
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-7722
Mailing Address - Country:US
Mailing Address - Phone:321-695-8597
Mailing Address - Fax:
Practice Address - Street 1:2500 MARTINWOOD DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4940
Practice Address - Country:US
Practice Address - Phone:321-695-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No347C00000XTransportation ServicesPrivate Vehicle
No374J00000XNursing Service Related ProvidersDoula