Individual
SUSILA SHANMUGANATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2390 W CONGRESS ST, LAFAYETTE, LA 70506-4205
(337) 991-9276
Mailing address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 991-9276
(337) 943-0846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207855
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2300458
—
LA
Enumeration date
05/24/2012
Last updated
07/21/2021
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