Individual
SHALINI GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4630 AMBASSADOR CAFFERY PKWY STE 102, LAFAYETTE, LA 70508-6949
(337) 470-4434
(337) 470-4432
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(337) 470-4434
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
204769
LA
208000000X
Pediatrics Physician
27990
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120787
—
AL
05
—
120790
—
AL
05
—
121204
—
AL
05
—
121205
—
AL
01
—
511-06829
BLUE CROSS BLUE SHIELD LOCATION ID
AL
01
—
511-08011
BCBS
AL
01
—
511-08012
BCBS
AL
01
—
511-08013
BCBS
AL
Enumeration date
05/22/2007
Last updated
12/20/2024
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