Healthcare Provider Details

I. General information

NPI: 1568371060
Provider Name (Legal Business Name): PETER BORRELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2657 N CAUSEWAY BLVD
MANDEVILLE LA
70471-6435
US

IV. Provider business mailing address

806 CARROLL ST
MANDEVILLE LA
70448-5115
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-5849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1408
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: