Provider Demographics
NPI:1023167616
Name:SURRATT, LASHAY RAVON SR
Entity type:Individual
Prefix:MR
First Name:LASHAY
Middle Name:RAVON
Last Name:SURRATT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NORTHCLIFFE DR APT 509
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3350
Mailing Address - Country:US
Mailing Address - Phone:336-918-4975
Mailing Address - Fax:
Practice Address - Street 1:2000 NORTHCLIFFE DR APT 509
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3350
Practice Address - Country:US
Practice Address - Phone:336-918-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide