Healthcare Provider Details

I. General information

NPI: 1013832955
Provider Name (Legal Business Name): SHARON SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 J W DAVIS DR STE D
HAMMOND LA
70403-3992
US

IV. Provider business mailing address

46193 DURBIN RD
HAMMOND LA
70401-4540
US

V. Phone/Fax

Practice location:
  • Phone: 985-974-8822
  • Fax:
Mailing address:
  • Phone: 225-620-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number338829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: