Healthcare Provider Details

I. General information

NPI: 1386954188
Provider Name (Legal Business Name): MRS. SHELLEY LONGSTREET CALAMIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 METAIRIE RD 106
METAIRIE LA
70005-4333
US

IV. Provider business mailing address

611 METAIRIE RD
METAIRIE LA
70005-4333
US

V. Phone/Fax

Practice location:
  • Phone: 504-835-7554
  • Fax:
Mailing address:
  • Phone: 504-390-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA 4095
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: