Healthcare Provider Details

I. General information

NPI: 1780406132
Provider Name (Legal Business Name): SHELBY PUTFARK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TULANE CENTER FOR CLINICAL NEUROSCIENCES 131 S ROBERTSON ST, STE 1300
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

3428 TENNESSEE AVE
KENNER LA
70065-3827
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: