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General NPI Number Information
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NPI Number | 1366354474
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Entity Type | Individual
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Provider Name | KENYA SHAW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 104 IVY CT
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City | RESERVE
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State | LA
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Zip | 70084-5505
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Country | US
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Telephone | 504-577-4331
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Fax | 504-814-8055
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Provider Business Mailing Address
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Address Line | 104 IVY CT
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City | RESERVE
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State | LA
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Zip | 70084-5505
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Country | US
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Telephone | 504-577-4331
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Fax | 504-814-8055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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