MEDICARE: EARLENE E. STRAYHORN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	036070318	IL
2	2084P0804X	Child & Adolescent Psychiatry Physician	01074448A	IN
3	2084P0804X	Child & Adolescent Psychiatry Physician	MD-21366	HI

General Provider Information

NPI Number	:	1134211246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARLENE E. STRAYHORN MD

Provider Business Mailing Address
First Line	:	2285 SEQUOIA DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60506-6209
Country	:	US
Telephone Number	:	630-859-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2301 OLD FT WEAVER RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-3602
Country	:	US
Telephone Number	:	808-677-2587
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/21/2023

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