Healthcare Provider Details

I. General information

NPI: 1407198690
Provider Name (Legal Business Name): SKYLAR AMANDA SOUYOUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 TURNPIKE ST
NORTH ANDOVER MA
01845-5812
US

IV. Provider business mailing address

145 ROBERT E LEE BLVD STE 302
NEW ORLEANS LA
70124-2593
US

V. Phone/Fax

Practice location:
  • Phone: 978-691-5690
  • Fax: 978-225-7837
Mailing address:
  • Phone: 504-777-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number302310
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number282659
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: