Basic Information
| Provider Information | |||||||||
| NPI: | 1124045620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PITRE | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 RIDGEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703012725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854479045 | ||||||||
| FaxNumber: | 9854473349 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 RIDGEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713012725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854479045 | ||||||||
| FaxNumber: | 9854473349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 09890R | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1651435 | 05 | LA | MEDICAID |