Provider Demographics
NPI:1568103752
Name:PRICE, SHANDA N
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:N
Last Name:PRICE
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 1:155 WILMA LN LOT 1
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-4562
Mailing Address - Country:US
Mailing Address - Phone:318-771-8388
Mailing Address - Fax:
Practice Address - Street 1:155 WILMA LN LOT 1
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-4562
Practice Address - Country:US
Practice Address - Phone:318-771-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No374U00000XNursing Service Related ProvidersHome Health Aide