Provider Demographics
NPI:1154921740
Name:COOPER, SHANTELL MARIA
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:MARIA
Last Name:COOPER
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 1:1716 FRANKEL AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-5049
Mailing Address - Country:US
Mailing Address - Phone:833-853-8746
Mailing Address - Fax:833-853-8746
Practice Address - Street 1:1716 FRANKEL AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-5049
Practice Address - Country:US
Practice Address - Phone:833-853-8746
Practice Address - Fax:833-853-8746
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)