Healthcare Provider Details

I. General information

NPI: 1952139909
Provider Name (Legal Business Name): MEAGAN EAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 INDEPENDENCE LN UNIT 263
MAITLAND FL
32751-5663
US

IV. Provider business mailing address

190 INDEPENDENCE LN UNIT 263
MAITLAND FL
32751-5663
US

V. Phone/Fax

Practice location:
  • Phone: 407-840-7534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: