Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane T Broussard, PA

Individual provider Physician Assistant · NPI 1164468435

Shane T Broussard, PA is a Physician Assistant in Lafayette, Louisiana. Licensed in Louisiana. Registered with an NPI since 2006.

Licensed in
LA
In the registry since
2006
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

1103 Kaliste Saloom Rd Ste 102
Lafayette, LA 70508-2920
Phone: (337) 234-5234
Fax: (337) 235-2121
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence A10272 (LA)

Record details

NPI number1164468435
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 22, 2006
Last updated in NPPESFebruary 3, 2009
Mailing address1103 Kaliste Saloom Road, Suite 102, Lafayette, LA 70508-2920

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