Provider Demographics
NPI:1629436522
Name:BYRD, SHENA
Entity Type:Individual
Prefix:
First Name:SHENA
Middle Name:
Last Name:BYRD
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 1:3147 WOODGLYNN DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814
Mailing Address - Country:US
Mailing Address - Phone:225-333-1142
Mailing Address - Fax:225-927-5804
Practice Address - Street 1:3147 WOODGLYNN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-2523
Practice Address - Country:US
Practice Address - Phone:225-927-5804
Practice Address - Fax:225-927-5804
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver