Individual
MISS MYRA DEANNE FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1440 CANAL ST, NEW ORLEANS, LA 70112-2703
(504) 988-5031
Mailing address
1440 CANAL ST, NEW ORLEANS, LA 70112-2703
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
DO.000467
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2300393
—
LA
Enumeration date
04/11/2012
Last updated
10/07/2016
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