Healthcare Provider Details

I. General information

NPI: 1487414652
Provider Name (Legal Business Name): ELISHA MYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR # 3K
DURHAM NC
27710-4000
US

IV. Provider business mailing address

26 N PINE CIR
BELLEAIR FL
33756-1640
US

V. Phone/Fax

Practice location:
  • Phone: 727-488-3268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberRTL25-0744
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: