Healthcare Provider Details

I. General information

NPI: 1003262304
Provider Name (Legal Business Name): DR. SHAUN CARPENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16453 COLORADO AVE
PARAMOUNT CA
90723-5011
US

IV. Provider business mailing address

PO BOX 1089
HAMMOND LA
70404-1089
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-7070
  • Fax: 985-892-7017
Mailing address:
  • Phone: 985-892-7070
  • Fax: 985-892-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TASHA MEARS
Title or Position: CAO
Credential: RN, BSN
Phone: 225-347-4975