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Individual

SHASA RENE HENRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPSGT

Contact information

Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25239
MS

Other

Enumeration date
03/19/2024
Last updated
03/19/2024
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