Healthcare Provider Details

I. General information

NPI: 1639006455
Provider Name (Legal Business Name): SARA RENEE EADELMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA RENEE BERGERON

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 CALHOUN ST
CHARLESTON SC
29425-8906
US

IV. Provider business mailing address

100 SALINAS CT
SUMMERVILLE SC
29483-8430
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-5252
  • Fax:
Mailing address:
  • Phone: 616-350-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: