Healthcare Provider Details

I. General information

NPI: 1932586310
Provider Name (Legal Business Name): CARLEIGH N ELDAYRIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 PORTER RD STE 207
WINTER GARDEN FL
34787-8915
US

IV. Provider business mailing address

17000 PORTER RD STE 207
WINTER GARDEN FL
34787-8915
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3013
  • Fax: 407-636-7844
Mailing address:
  • Phone: 407-635-3013
  • Fax: 407-636-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME141747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018-01886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: