Provider Demographics
NPI:1598137713
Name:SHAMIEH, DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:SHAMIEH
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 1:6200 FAUSSE BAYOU DR
Mailing Address - Street 2:
Mailing Address - City:VENTRESS
Mailing Address - State:LA
Mailing Address - Zip Code:70783-3917
Mailing Address - Country:US
Mailing Address - Phone:225-532-9041
Mailing Address - Fax:
Practice Address - Street 1:6200 FAUSSE BAYOU DR
Practice Address - Street 2:
Practice Address - City:VENTRESS
Practice Address - State:LA
Practice Address - Zip Code:70783-3917
Practice Address - Country:US
Practice Address - Phone:225-532-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600964601Medicaid