Individual
SHANIKA BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6163 E LAMAR ST, BAY SAINT LOUIS, MS 39520-8267
(504) 908-5893
Mailing address
1110 COWAN RD., SUITE B #2014, GULFPORT, MS 39507
(228) 254-3037
(228) 335-6029
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
MS
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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