MEDICARE: SEAN DONALD EBERHARD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	27151	SC
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	244943	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	244943	OTHER		RN

General Provider Information

NPI Number	:	1063121044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN DONALD EBERHARD APRN

Provider Business Mailing Address
First Line	:	3527 DUNMOVIN DR
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8421
Country	:	US
Telephone Number	:	843-437-6511
Fax Number	:

Provider Business Practice Location Address
First Line	:	2079 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5834
Country	:	US
Telephone Number	:	843-974-5622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	06/17/2026

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