Healthcare Provider Details

I. General information

NPI: 1548176464
Provider Name (Legal Business Name): DANIEL EDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 ERSKINE LANE SUITE B
SCOTT DEPOT WV
25560
US

IV. Provider business mailing address

707 14TH ST W APT 4
HUNTINGTON WV
25704-2362
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-2800
  • Fax: 304-741-3844
Mailing address:
  • Phone: 304-543-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: