Provider Demographics
NPI:1356096515
Name:GALLOW, SHAUNTELLA LATRICE
Entity Type:Individual
Prefix:
First Name:SHAUNTELLA
Middle Name:LATRICE
Last Name:GALLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:CHATAIGNIER
Mailing Address - State:LA
Mailing Address - Zip Code:70524-0005
Mailing Address - Country:US
Mailing Address - Phone:337-290-6102
Mailing Address - Fax:
Practice Address - Street 1:376 FIRST ST.
Practice Address - Street 2:
Practice Address - City:CHATAIGNIER
Practice Address - State:LA
Practice Address - Zip Code:70524
Practice Address - Country:US
Practice Address - Phone:337-290-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator