Healthcare Provider Details

I. General information

NPI: 1407087034
Provider Name (Legal Business Name): SHANI GORIO BOOTH ANP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42334 DELUXE PLZ STE 2
HAMMOND LA
70403-1237
US

IV. Provider business mailing address

1752 OX BOW LN
COVINGTON LA
70433-7273
US

V. Phone/Fax

Practice location:
  • Phone: 985-662-5520
  • Fax:
Mailing address:
  • Phone: 985-507-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP05920
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP05920
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: