Provider Demographics
NPI:1770389900
Name:BLANDA, SHELLEY SMITH (APRN, PMHNP-BC, RN)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SMITH
Last Name:BLANDA
Suffix:
Gender:
Credentials:APRN, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WOODRUFF DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4164
Mailing Address - Country:US
Mailing Address - Phone:985-707-7693
Mailing Address - Fax:
Practice Address - Street 1:118 WOODRUFF DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4164
Practice Address - Country:US
Practice Address - Phone:985-707-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201780363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner