Provider Demographics
NPI:1235018482
Name:BROUSSARD, SHAMEECA
Entity type:Individual
Prefix:
First Name:SHAMEECA
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91246
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-1246
Mailing Address - Country:US
Mailing Address - Phone:337-422-7871
Mailing Address - Fax:337-770-2696
Practice Address - Street 1:138 GALLIAN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6425
Practice Address - Country:US
Practice Address - Phone:337-422-7871
Practice Address - Fax:337-770-2696
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver