Healthcare Provider Details

I. General information

NPI: 1073437117
Provider Name (Legal Business Name): SHANTEL LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 DRUSILLA LN STE A1129
BATON ROUGE LA
70809-1495
US

IV. Provider business mailing address

13062 EAGLES WAY CT
GEISMAR LA
70734-3059
US

V. Phone/Fax

Practice location:
  • Phone: 225-362-9774
  • Fax: 225-487-9005
Mailing address:
  • Phone: 225-362-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: