Healthcare Provider Details

I. General information

NPI: 1548153125
Provider Name (Legal Business Name): ELIZABETH JAYDE BERNSTEIN 101YM0800X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 SUN VALLEY DR
FORT PIERCE FL
34951-3132
US

IV. Provider business mailing address

5605 SUN VALLEY DR
FORT PIERCE FL
34951-3132
US

V. Phone/Fax

Practice location:
  • Phone: 772-284-5776
  • Fax:
Mailing address:
  • Phone: 772-284-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberISW20910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: