Provider Demographics
NPI:1023760105
Name:LASSITER, SHANINA TRALICE (DFM, DTN, PHD)
Entity type:Individual
Prefix:DR
First Name:SHANINA
Middle Name:TRALICE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:DFM, DTN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 PEACHTREE DUNWOODY RD STE E101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4513
Mailing Address - Country:US
Mailing Address - Phone:678-561-4522
Mailing Address - Fax:678-561-1297
Practice Address - Street 1:6111 PEACHTREE DUNWOODY RD STE E101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4513
Practice Address - Country:US
Practice Address - Phone:678-561-4522
Practice Address - Fax:678-561-1297
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopath
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty