Healthcare Provider Details

I. General information

NPI: 1407533086
Provider Name (Legal Business Name): ELEANORE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PIEDMONT BLVD STE 100
ROCK HILL SC
29732-1836
US

IV. Provider business mailing address

205 PIEDMONT BLVD STE 100
ROCK HILL SC
29732-1836
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-2012
  • Fax: 803-327-4198
Mailing address:
  • Phone: 803-327-2012
  • Fax: 803-327-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: