Healthcare Provider Details

I. General information

NPI: 1124603204
Provider Name (Legal Business Name): CHAYA EADDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 MAURITANIA RD
PUNTA GORDA FL
33983-8656
US

IV. Provider business mailing address

2757 MAURITANIA RD
PUNTA GORDA FL
33983-8656
US

V. Phone/Fax

Practice location:
  • Phone: 941-421-2352
  • Fax:
Mailing address:
  • Phone: 941-421-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: