Healthcare Provider Details

I. General information

NPI: 1245647577
Provider Name (Legal Business Name): SWATHI MOYLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TILDEN ST
BRONX NY
10467-6013
US

IV. Provider business mailing address

750 TILDEN ST
BRONX NY
10467-6013
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-3400
  • Fax:
Mailing address:
  • Phone: 718-231-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number294090
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number294090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: