Basic Information
| Provider Information | |||||||||
| NPI: | 1871811133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRISBY | ||||||||
| FirstName: | SHAUNDA | ||||||||
| MiddleName: | KATRISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 S COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375711300 | ||||||||
| FaxNumber: | 3375711301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1448 S COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375711300 | ||||||||
| FaxNumber: | 3375711301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2010 | ||||||||
| LastUpdateDate: | 07/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 307013 | LA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.