Provider Demographics
NPI:1053905612
Name:BASTANI, LAKYN DANIELE (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:LAKYN
Middle Name:DANIELE
Last Name:BASTANI
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:MRS
Other - First Name:LAKYN
Other - Middle Name:DANIELE
Other - Last Name:DUNIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:2620 BROADWAY STREET
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-3177
Mailing Address - Country:US
Mailing Address - Phone:270-442-3561
Mailing Address - Fax:270-442-4404
Practice Address - Street 1:2620 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-3177
Practice Address - Country:US
Practice Address - Phone:270-442-3561
Practice Address - Fax:270-442-4404
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
KY261818237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist