Provider Demographics
NPI:1831678234
Name:GASKIN, SHONDA YVONNE
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:YVONNE
Last Name:GASKIN
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 1:8978 BRANDON DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2327
Mailing Address - Country:US
Mailing Address - Phone:318-469-3162
Mailing Address - Fax:
Practice Address - Street 1:2210 LINE AVE STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2134
Practice Address - Country:US
Practice Address - Phone:318-675-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator