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General NPI Number Information
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NPI Number | 1629211958
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Entity Type | Individual
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Provider Name | SHENEDA L JACKSON RD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 111 N CAUSEWAY BLVD
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City | METAIRIE
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State | LA
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Zip | 70001-5450
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Country | US
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Telephone | 504-838-5100
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Fax | 504-838-5104
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Provider Business Mailing Address
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Address Line | 21 DAUTERIVE CT
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City | KENNER
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State | LA
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Zip | 70065-2478
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Country | US
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Telephone | 504-473-1106
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1730
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License Number State | LA
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