Provider Demographics
NPI:1154691962
Name:LAUREANO, MYRTA S (MD)
Entity type:Individual
Prefix:DR
First Name:MYRTA
Middle Name:S
Last Name:LAUREANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SW SUNDANCE TRL
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-8223
Mailing Address - Country:US
Mailing Address - Phone:561-512-1532
Mailing Address - Fax:
Practice Address - Street 1:545 SW SUNDANCE TRL
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-8223
Practice Address - Country:US
Practice Address - Phone:561-512-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 280992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry