Provider Demographics
NPI:1669879672
Name:COOPER, SHELBY VALORA (HS)
Entity type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:VALORA
Last Name:COOPER
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 SATURN BLVD
Mailing Address - Street 2:USCG MEDICAL CLINIC
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129
Mailing Address - Country:US
Mailing Address - Phone:504-253-4671
Mailing Address - Fax:
Practice Address - Street 1:1790 SATURN BLVD
Practice Address - Street 2:USCG MEDICAL CLINIC
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129
Practice Address - Country:US
Practice Address - Phone:504-253-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman