Provider Demographics
NPI:1417325218
Name:SHAFTO, NICOLETTE DENEE (PA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:DENEE
Last Name:SHAFTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 7000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0307
Mailing Address - Country:US
Mailing Address - Phone:225-215-2255
Mailing Address - Fax:225-215-2266
Practice Address - Street 1:7777 HENNESSY BLVD STE 7000
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-0307
Practice Address - Country:US
Practice Address - Phone:225-215-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200885363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical