Provider Demographics
NPI:1912449521
Name:BAYONNE, MAYSHONNA WINSLOW
Entity type:Individual
Prefix:
First Name:MAYSHONNA
Middle Name:WINSLOW
Last Name:BAYONNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAYSHONNA
Other - Middle Name:SHEBELL
Other - Last Name:WINSLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 VAUGHN ST
Mailing Address - Street 2:
Mailing Address - City:CAMPTI
Mailing Address - State:LA
Mailing Address - Zip Code:71411-4014
Mailing Address - Country:US
Mailing Address - Phone:318-521-4120
Mailing Address - Fax:
Practice Address - Street 1:138 VAUGHN ST
Practice Address - Street 2:
Practice Address - City:CAMPTI
Practice Address - State:LA
Practice Address - Zip Code:71411
Practice Address - Country:US
Practice Address - Phone:318-521-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171M00000X
LA14938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator