MEDICARE: SHEIRA NEELY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	203691	LA
2	208000000X	Pediatrics Physician	203691	LA

General Provider Information

NPI Number	:	1487111548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEIRA NEELY NP

Provider Business Mailing Address
First Line	:	543 KIMBERLY ANN DR
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-6712
Country	:	US
Telephone Number	:	504-881-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 KEYSTONE BLVD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-7525
Country	:	US
Telephone Number	:	985-893-3395
Fax Number	:	985-892-8212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	06/03/2026

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Directions to “ SHEIRA NEELY NP” Practice Location

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