Healthcare Provider Details

I. General information

NPI: 1851031561
Provider Name (Legal Business Name): TAYLOR FRADELLA-DOUCET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15795 PAUL VEGA MD DRIVE
HAMMOND LA
70403
US

IV. Provider business mailing address

2215 RUE WELLER
MANDEVILLE LA
70448-2348
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7525
  • Fax: 985-230-7335
Mailing address:
  • Phone: 985-774-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number351619
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: