Provider Demographics
NPI:1407826464
Name:ANASTASIO, SHELLY (OD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:ANASTASIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 OCHSNER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8110
Mailing Address - Country:US
Mailing Address - Phone:985-875-7898
Mailing Address - Fax:985-875-9844
Practice Address - Street 1:1431 OCHSNER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8110
Practice Address - Country:US
Practice Address - Phone:985-875-7898
Practice Address - Fax:985-875-9844
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1355-489T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150461Medicaid
LA4B282Medicare PIN
LA1150461Medicaid