Healthcare Provider Details

I. General information

NPI: 1679442248
Provider Name (Legal Business Name): AETHERAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 NE 28TH ST
POMPANO BEACH FL
33064-6816
US

IV. Provider business mailing address

1398 NE 28TH ST
POMPANO BEACH FL
33064-6816
US

V. Phone/Fax

Practice location:
  • Phone: 954-605-6224
  • Fax:
Mailing address:
  • Phone: 954-605-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER LYNDON EDDY
Title or Position: FOUNDER & MEDICAL DIRECTOR
Credential: MD
Phone: 954-605-6224