Provider Demographics
NPI:1720648934
Name:COLLINS, SHYNEISHA V
Entity Type:Individual
Prefix:
First Name:SHYNEISHA
Middle Name:V
Last Name:COLLINS
Suffix:
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 1:46476 HEATHERWOOD DR # 1
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-5410
Mailing Address - Country:US
Mailing Address - Phone:225-776-0411
Mailing Address - Fax:
Practice Address - Street 1:11616 SOUTHFORK AVE STE 203
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5241
Practice Address - Country:US
Practice Address - Phone:225-291-9718
Practice Address - Fax:225-960-2361
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator