Healthcare Provider Details

I. General information

NPI: 1952846362
Provider Name (Legal Business Name): LUDMILA DEARAUJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CLOVIS CIR
MYRTLE BEACH SC
29579-8212
US

IV. Provider business mailing address

15 SHADOWBROOK LN APT 29
MILFORD MA
01757-1139
US

V. Phone/Fax

Practice location:
  • Phone: 774-287-3308
  • Fax:
Mailing address:
  • Phone: 774-287-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number31761
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: