MEDICARE: SDV HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1184215568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SDV HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	4520 S. SHERWOOD FOREST SUITE 104
Second Line	:	#389
City	:	BATON ROUGE
State	:	LA
Zip	:	70816
Country	:	US
Telephone Number	:	225-229-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 WESTFORK DR STE B
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2252
Country	:	US
Telephone Number	:	225-229-3254
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MRS. DAWN MELANCON
Credential	:	NP
Telephone Number	:	225-301-2982

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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Directions to “SDV HEALTHCARE LLC ” Practice Location

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