Healthcare Provider Details

I. General information

NPI: 1972130375
Provider Name (Legal Business Name): SHELBY BUCKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 498
JACKSON LA
70748-0498
US

IV. Provider business mailing address

1440 CANAL ST # 8448
NEW ORLEANS LA
70112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 225-634-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number332505
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number332505
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: