Provider Demographics
NPI:1104896919
Name:MARIANO, SHEILA (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2062
Mailing Address - Country:US
Mailing Address - Phone:318-395-3051
Mailing Address - Fax:
Practice Address - Street 1:121 WATTS ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2062
Practice Address - Country:US
Practice Address - Phone:318-395-3051
Practice Address - Fax:318-395-3052
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13651R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH28697Medicare UPIN
LA0599520002Medicare NSC