Provider Demographics
NPI:1871702225
Name:GRANT, SHALINI (MD)
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-4434
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-470-4434
Practice Address - Fax:337-470-4432
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27990208000000X
LA204769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-08013OtherBCBS
AL121204Medicaid
AL121205Medicaid
AL511-08011OtherBCBS
AL511-08012OtherBCBS
AL120787Medicaid
AL120790Medicaid
AL511-06829OtherBLUE CROSS BLUE SHIELD LOCATION ID