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NPI Code Detail

MEDICARE: DR. SKYLAR AMANDA SOUYOUL M.D.

MEDICARE: DR. SKYLAR AMANDA SOUYOUL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician302310LA
2207N00000XDermatology Physician282659MA

General Provider Information

NPI Number : 1407198690
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SKYLAR AMANDA SOUYOUL M.D.
Provider Business Mailing Address
First Line : 145 ROBERT E LEE BLVD STE 302
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70124-2593
Country : US
Telephone Number : 504-777-3047
Fax Number :
Provider Business Practice Location Address
First Line : 538 TURNPIKE ST
Second Line :
City : NORTH ANDOVER
State : MA
Zip : 01845-5812
Country : US
Telephone Number : 978-691-5690
Fax Number : 978-225-7837
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2013
Last Update Date : 07/02/2020

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