Provider Demographics
NPI:1851185649
Name:JOHNSON, SHAROYALE
Entity type:Individual
Prefix:
First Name:SHAROYALE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4587 HIGHWAY 80 LOT 44
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8955
Mailing Address - Country:US
Mailing Address - Phone:318-607-7183
Mailing Address - Fax:
Practice Address - Street 1:2807 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3749
Practice Address - Country:US
Practice Address - Phone:318-654-7667
Practice Address - Fax:318-816-7524
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator