Healthcare Provider Details

I. General information

NPI: 1104718089
Provider Name (Legal Business Name): LIAM ELI UNDERWOOD-PRICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SUFFERN PL STE A
SUFFERN NY
10901-5566
US

IV. Provider business mailing address

73 WOODSIDE TER
NEW HAVEN CT
06515-2020
US

V. Phone/Fax

Practice location:
  • Phone: 357-450-0845
  • Fax:
Mailing address:
  • Phone: 203-627-8638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number758375
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number758375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: