Provider Demographics
NPI:1124719885
Name:PHIPPS, SHERANDA DEVONA
Entity type:Individual
Prefix:
First Name:SHERANDA
Middle Name:DEVONA
Last Name:PHIPPS
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 1:2601 TULANE AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7461
Mailing Address - Country:US
Mailing Address - Phone:504-582-9911
Mailing Address - Fax:504-582-9311
Practice Address - Street 1:2601 TULANE AVE STE 615
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7461
Practice Address - Country:US
Practice Address - Phone:504-582-9911
Practice Address - Fax:504-582-9311
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA335599202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology