Individual
DR. LARISSA SOPHIA DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
201 LYONS AVE, SUITE D11, NEWARK, NJ 07112-2027
(973) 926-6671
Mailing address
2627 W EAU GALLIE BLVD STE 101, MELBOURNE, FL 32935-8303
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME131434
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2013
Last updated
07/02/2024
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