Provider Demographics
NPI:1609434430
Name:DUPART, SHANTRESE KENETRA (DO)
Entity type:Individual
Prefix:DR
First Name:SHANTRESE
Middle Name:KENETRA
Last Name:DUPART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4710 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6027
Mailing Address - Country:US
Mailing Address - Phone:504-454-9020
Mailing Address - Fax:504-454-9031
Practice Address - Street 1:4710 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6027
Practice Address - Country:US
Practice Address - Phone:504-454-9020
Practice Address - Fax:504-454-9031
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA338610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine