Provider Demographics
NPI:1851922595
Name:SMITH, SHANNEL SR
Entity Type:Individual
Prefix:
First Name:SHANNEL
Middle Name:
Last Name:SMITH
Suffix:SR
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 1:5001 NEW YORK CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1032
Mailing Address - Country:US
Mailing Address - Phone:504-377-3804
Mailing Address - Fax:
Practice Address - Street 1:5001 NEW YORK CIR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1032
Practice Address - Country:US
Practice Address - Phone:504-377-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA84-4532591OtherIRS