Healthcare Provider Details

I. General information

NPI: 1093698268
Provider Name (Legal Business Name): TAYLOR EADIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR STE 498
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR STE 498
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 254-394-8212
  • Fax:
Mailing address:
  • Phone: 254-394-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: