Healthcare Provider Details

I. General information

NPI: 1255034625
Provider Name (Legal Business Name): JOSHUA SCUDERI PLPC, NCC, CIT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N FLORIDA ST
COVINGTON LA
70433-2997
US

IV. Provider business mailing address

1531 MARIGNY AVE
MANDEVILLE LA
70448-3846
US

V. Phone/Fax

Practice location:
  • Phone: 504-635-3535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8866
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: