MEDICARE: SANDRITA MONIQUE EADDY FNP

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
1	163W00000X	Registered Nurse	238251	SC

General Provider Information

NPI Number	:	1548819188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRITA MONIQUE EADDY FNP

Provider Business Mailing Address
First Line	:	516 BRODY PARK RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-898-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2715 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-898-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	02/25/2026

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