MEDICARE: SHELBY BUCKLEY MD

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	2084P0800X	Psychiatry Physician	332505	LA
2	2084F0202X	Forensic Psychiatry Physician	332505	LA

General Provider Information

NPI Number	:	1972130375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY BUCKLEY MD

Provider Business Mailing Address
First Line	:	1440 CANAL ST # 8448
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 498
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748-0498
Country	:	US
Telephone Number	:	225-634-0100
Fax Number	:

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

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	06/30/2025

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Directions to “ SHELBY BUCKLEY MD” Practice Location

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