Provider Demographics
NPI:1891734190
Name:JONES, SHAUNDA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNDA
Middle Name:P
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAUNDA
Other - Middle Name:P
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE N304
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6465
Mailing Address - Fax:504-349-6468
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE N304
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6465
Practice Address - Fax:504-349-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0211452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1986461Medicaid
LA1986461Medicaid
LA5U210Medicare PIN