MEDICARE: ROCHELLE D. ELAYDA FNP

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	363LF0000X	Family Nurse Practitioner	21560	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336649953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHELLE D. ELAYDA FNP

Provider Business Mailing Address
First Line	:	PO BOX 530062
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0062
Country	:	US
Telephone Number	:	843-695-6071
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	1101 OLD TROLLEY RD STE 100
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5294
Country	:	US
Telephone Number	:	843-875-0400
Fax Number	:	843-871-6700

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	07/06/2021

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