Healthcare Provider Details

I. General information

NPI: 1073496881
Provider Name (Legal Business Name): ASIA EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 E FOUNTAIN BLVD STE 245
COLORADO SPRINGS CO
80910-7705
US

IV. Provider business mailing address

6235 TWIN OAKS DR APT 2315
COLORADO SPRINGS CO
80918-8318
US

V. Phone/Fax

Practice location:
  • Phone: 719-696-9027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: