Provider Demographics
NPI:1528640620
Name:CASBY, SHONDRA L
Entity type:Individual
Prefix:MS
First Name:SHONDRA
Middle Name:L
Last Name:CASBY
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 1:1050 S JEFFERSON DAVIS PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1234
Mailing Address - Country:US
Mailing Address - Phone:504-821-7085
Mailing Address - Fax:504-304-2276
Practice Address - Street 1:1050 S. JEFFERSON DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125
Practice Address - Country:US
Practice Address - Phone:504-821-7085
Practice Address - Fax:504-304-2276
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213390163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7930114737Medicaid