| Doctor Name: | SHELLY PENDERGRASS |
| NPI Number: | 1417338724 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 200820 |
| Business Practice Address: | 217 Railroad Ave Donaldsonville, LA - 703462527 |
| Business Phone Number: | 2254733931 |
| Business Fax Number: | |
| Mailing Address: | 17075 Fox Ridge Dr, PRAIRIEVILLE |
| State: | LA |
| Postal Code: | 707694834 |
| Phone Number: | 2252356696 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2015 |
| NPI Last Update Date: | 06/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 200820 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |