Healthcare Provider Details

I. General information

NPI: 1679483598
Provider Name (Legal Business Name): DYNASTI CHERISH SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 CROWDER BLVD
NEW ORLEANS LA
70127-4083
US

IV. Provider business mailing address

4516 CROWDER BLVD
NEW ORLEANS LA
70127-4083
US

V. Phone/Fax

Practice location:
  • Phone: 504-762-0305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: