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General NPI Number Information
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NPI Number | 1649376401
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Entity Type | Individual
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Provider Name | SHAWN MORETA HUMPHRIES M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 W 134TH PL
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City | CUT OFF
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State | LA
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Zip | 70345-4143
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Country | US
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Telephone | 985-632-8256
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Fax | 985-325-8417
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Provider Business Mailing Address
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Address Line | 4104 CHATEAU BLVD CONDO C
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City | KENNER
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State | LA
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Zip | 70065-5721
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Country | US
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Telephone | 504-464-7557
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Fax | 985-325-8417
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 06675R
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License Number State | LA
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