Healthcare Provider Details

I. General information

NPI: 1013710565
Provider Name (Legal Business Name): KINGSTONDEV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

IV. Provider business mailing address

508 MILLAUDON ST
NEW ORLEANS LA
70118-3805
US

V. Phone/Fax

Practice location:
  • Phone: 504-249-3805
  • Fax:
Mailing address:
  • Phone: 504-881-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMA MADDOX
Title or Position: SURGEON
Credential: MD
Phone: 504-249-3805