Healthcare Provider Details

I. General information

NPI: 1225244882
Provider Name (Legal Business Name): BEVERLY EADIE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4054 SAWYER RD
SARASOTA FL
34233-1272
US

IV. Provider business mailing address

4054 SAWYER RD
SARASOTA FL
34233-1272
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-1189
  • Fax: 941-365-8635
Mailing address:
  • Phone: 941-552-1189
  • Fax: 941-365-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS8817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: