Healthcare Provider Details

I. General information

NPI: 1518319615
Provider Name (Legal Business Name): SHAWNA SEZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 W BAYOU PINES DR STE A
LAKE CHARLES LA
70601-7096
US

IV. Provider business mailing address

2525 YOUREE DR STE 110
SHREVEPORT LA
71104-3600
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-3292
  • Fax:
Mailing address:
  • Phone: 318-742-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: