Healthcare Provider Details

I. General information

NPI: 1639008857
Provider Name (Legal Business Name): SHERELLAQUATAY MARSHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PARKVIEW ST
MANSFIELD LA
71052-6447
US

IV. Provider business mailing address

110 PARKVIEW ST
MANSFIELD LA
71052-6447
US

V. Phone/Fax

Practice location:
  • Phone: 318-461-7228
  • Fax:
Mailing address:
  • Phone: 318-461-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberB086012
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: