Healthcare Provider Details

I. General information

NPI: 1619729407
Provider Name (Legal Business Name): MITI-SHELLA DORZEUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD
METAIRIE LA
70006-3000
US

IV. Provider business mailing address

4228 HOUMA BLVD
METAIRIE LA
70006-3000
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-7878
  • Fax:
Mailing address:
  • Phone: 504-454-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number348958
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number348958
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: