Provider Demographics
NPI:1417287939
Name:CEASAR, SHAUNTEL RENEE
Entity Type:Individual
Prefix:MRS
First Name:SHAUNTEL
Middle Name:RENEE
Last Name:CEASAR
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 959
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-0959
Mailing Address - Country:US
Mailing Address - Phone:337-377-3627
Mailing Address - Fax:337-439-2120
Practice Address - Street 1:9236 BARN STABLE DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-0893
Practice Address - Country:US
Practice Address - Phone:337-377-3627
Practice Address - Fax:337-439-2120
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information