Healthcare Provider Details

I. General information

NPI: 1477470284
Provider Name (Legal Business Name): HYDRATION HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 BEHRMAN HWY STE 103
TERRYTOWN LA
70056-4546
US

IV. Provider business mailing address

842 BEHRMAN HWY STE 103
TERRYTOWN LA
70056-4546
US

V. Phone/Fax

Practice location:
  • Phone: 504-450-6682
  • Fax:
Mailing address:
  • Phone: 504-450-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELBY LYNN FOURROUX
Title or Position: OWNER/PROVIDER
Credential: FNP
Phone: 504-458-6337