Provider Demographics
NPI:1780240390
Name:SHELTON-ROGERS, SHANTEL
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:
Last Name:SHELTON-ROGERS
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 1:3004 KNIGHT ST STE 149
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2502
Mailing Address - Country:US
Mailing Address - Phone:318-227-8390
Mailing Address - Fax:318-429-2414
Practice Address - Street 1:3004 KNIGHT ST STE 149
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2502
Practice Address - Country:US
Practice Address - Phone:318-227-8390
Practice Address - Fax:318-429-2414
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18706104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker