Individual
SHANTELLA D CASNAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20495 HENRY CLAY AVE, COVINGTON, LA 70433-5379
(504) 881-3218
Mailing address
20495 HENRY CLAY AVE, COVINGTON, LA 70433-5379
(504) 881-3218
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
007798015
LA
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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