Healthcare Provider Details

I. General information

NPI: 1568173664
Provider Name (Legal Business Name): STARR L. EADDY PHD, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD
AIEA HI
96701-4777
US

IV. Provider business mailing address

98-1005 MOANALUA RD
AIEA HI
96701-4777
US

V. Phone/Fax

Practice location:
  • Phone: 646-602-8237
  • Fax:
Mailing address:
  • Phone: 646-602-8237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5572
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350949
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number666934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: