Provider Demographics
NPI:1356514210
Name:SCIACCA, HEYDIE KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:HEYDIE
Middle Name:KAREN
Last Name:SCIACCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 W AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5712
Mailing Address - Country:US
Mailing Address - Phone:985-479-4080
Mailing Address - Fax:985-479-4090
Practice Address - Street 1:4080 W AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5712
Practice Address - Country:US
Practice Address - Phone:985-479-4080
Practice Address - Fax:985-479-4090
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07156R314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956732Medicaid
LA552965Medicare PIN
LA1956732Medicaid