Provider Demographics
NPI:1770286411
Name:BRIGNAC, SHAWN CHRISTOPHER JR
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CHRISTOPHER
Last Name:BRIGNAC
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12179 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3027
Mailing Address - Country:US
Mailing Address - Phone:225-264-7202
Mailing Address - Fax:
Practice Address - Street 1:12179 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3027
Practice Address - Country:US
Practice Address - Phone:225-264-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program