Provider Demographics
NPI:1568957652
Name:SHIELD, CELESTE ANTOINETTE
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:ANTOINETTE
Last Name:SHIELD
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 1:1100 LAKE FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8317
Mailing Address - Country:US
Mailing Address - Phone:904-309-3267
Mailing Address - Fax:
Practice Address - Street 1:1100 LAKE FRANCES DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8317
Practice Address - Country:US
Practice Address - Phone:904-309-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42641603K347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle