Healthcare Provider Details

I. General information

NPI: 1972196822
Provider Name (Legal Business Name): SARAH DEROUEN MONEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WOODSTONE DR
LAFAYETTE LA
70508-8163
US

IV. Provider business mailing address

203 WOODSTONE DR
LAFAYETTE LA
70508-8163
US

V. Phone/Fax

Practice location:
  • Phone: 985-688-9565
  • Fax:
Mailing address:
  • Phone: 985-688-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7783
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: