Healthcare Provider Details

I. General information

NPI: 1306290499
Provider Name (Legal Business Name): TYLER SCULLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 EUTERPE ST APT 9208
NEW ORLEANS LA
70130-8626
US

IV. Provider business mailing address

810 EUTERPE ST APT 9208
NEW ORLEANS LA
70130-8626
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-7214
  • Fax:
Mailing address:
  • Phone:
  • 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 StateLA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number321278-01
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: