Healthcare Provider Details

I. General information

NPI: 1699033225
Provider Name (Legal Business Name): TYLER SANDOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY BRENT HOUSE ROOM 634
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1514 JEFFERSON HWY BRENT HOUSE ROOM 634
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3000
  • Fax:
Mailing address:
  • Phone: 504-842-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number305387
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number305387
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: