SHANE T BROUSSARD P.A.
NPI 1164468435
Physician Assistant in Lafayette, LA

Active since June 22, 2006
1103 KALISTE SALOOM ROAD, SUITE 102, LAFAYETTE, LA 70508(337) 234-5234(337) 235-2121 Get Directions Write a Review

NPPES record last updated: February 3, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shane T Broussard P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE T BROUSSARD P.A. (NPI 1164468435) is an individual physician assistant in Lafayette, Louisiana, licensed in Louisiana (A10272) and active in the NPI registry since June 2006.

NPPES Registry Identity

NPI1164468435
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameSHANE T BROUSSARDCredential: P.A.
Location Address1103 KALISTE SALOOM ROAD, SUITE 102Lafayette, LA 70508-2920
Mailing Address1103 Kaliste Saloom Road, Suite 102Lafayette, LA 70508-2920 · (337) 234-5234 · Fax (337) 235-2121
Fax(337) 235-2121
Sole ProprietorNo
Enumeration DateJune 22, 2006
Last NPPES UpdateFebruary 3, 2009
NPI 1164468435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in LA · A10272
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1103 KALISTE SALOOM ROAD, Lafayette, LA 70508

Other Identifiers 4

Medicare PIN5U977P751LA
Medicare PINP00352985LA
Medicare PIN5U998P172LA
Medicare PIN5DD85P997LA

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Orthopaedic Surgery
1103 KALISTE SALOOM ROAD, SUITE 100
LAFAYETTE, LA 70508
Orthopaedic Surgery
1103 KALISTE SALOOM ROAD, SUITE 102
LAFAYETTE, LA 70508
Orthopaedic Surgery
1103 KALISTE SALOOM ROAD, SUITE 100
LAFAYETTE, LA 70508
Orthopaedic Surgery
1103 KALISTE SALOOM ROAD, SUITE 100
LAFAYETTE, LA 70508
Physician Assistant (Surgical)
1103 KALISTE SALOOM ROAD, SUITE 100
LAFAYETTE, LA 70508
Physician Assistant (Surgical)
1103 KALISTE SALOOM ROAD, SUITE 102
LAFAYETTE, LA 70508
Physical Therapist
1103 KALISTE SALOOM ROAD, SUITE 104
LAFAYETTE, LA 70508
Orthopaedic Surgery
1103 KALISTE SALOOM ROAD, SUITE 100
LAFAYETTE, LA 70508

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Broussard's NPI number?

The NPI number for Shane Broussard is 1164468435. It was assigned to this individual provider in the NPPES registry on June 22, 2006.

Where is Shane Broussard located?

Shane Broussard practices at 1103 Kaliste Saloom Road Suite 102, Lafayette, LA 70508. The listed phone number is (337) 234-5234.

What is Shane Broussard's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Shane Broussard was last updated on February 3, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.