Healthcare Provider Details

I. General information

NPI: 1801003827
Provider Name (Legal Business Name): ANGELA SHERELL BYRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD SUITE 103
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

7777 HENNESSY BLVD SUITE 103
BATON ROUGE LA
70808-4300
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-6700
  • Fax: 225-766-6721
Mailing address:
  • Phone: 225-767-6700
  • Fax: 225-766-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number204331
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204331
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: