Healthcare Provider Details

I. General information

NPI: 1770286411
Provider Name (Legal Business Name): SHAWN CHRISTOPHER BRIGNAC JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE STE 412
KENNER LA
70065-2475
US

IV. Provider business mailing address

200 W ESPLANADE AVE STE 412
KENNER LA
70065-2475
US

V. Phone/Fax

Practice location:
  • Phone: 225-264-7202
  • Fax:
Mailing address:
  • Phone: 225-264-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: