Healthcare Provider Details

I. General information

NPI: 1750353207
Provider Name (Legal Business Name): GAELYN ELIZABETH LEE SCUDERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAELYN ELIZABETH LEE EATON-SCUDERI M.D.

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W. 8TH STREET UNIVERSITY OF FLORIDA DEPARTMENT OF RADIOLOGY
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

PO BOX 44008 PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-4225
  • Fax:
Mailing address:
  • Phone: 904-383-1024
  • Fax: 904-244-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME92004
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberME92004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: