Provider Demographics
NPI:1134648447
Name:MAJESTY, SHANA ALBRIGHT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ALBRIGHT
Last Name:MAJESTY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21184 LEE LN
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-5350
Mailing Address - Country:US
Mailing Address - Phone:985-981-6470
Mailing Address - Fax:985-981-6470
Practice Address - Street 1:112 LAKE ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6794
Practice Address - Country:US
Practice Address - Phone:985-370-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist