Provider Demographics
NPI:1124045620
Name:PITRE, SHEILA G (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:G
Last Name:PITRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2725
Mailing Address - Country:US
Mailing Address - Phone:985-447-9045
Mailing Address - Fax:985-447-3349
Practice Address - Street 1:807 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:71301-2725
Practice Address - Country:US
Practice Address - Phone:985-447-9045
Practice Address - Fax:985-447-3349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09890R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1651435Medicaid
LA1651435Medicaid
LA5W089Medicare ID - Type Unspecified