Provider Demographics
NPI:1205811858
Name:HART, SHANA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 VETERANS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-665-4554
Mailing Address - Fax:225-665-6995
Practice Address - Street 1:311 VETERANS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-665-4554
Practice Address - Fax:225-665-6995
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023680207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484423Medicaid
LAH62062Medicare UPIN
LA248201YJA2Medicare PIN