MEDICARE: MISS SHERYL MELISSA EAGLIN MED,MS,LAT

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	2255A2300X	Athletic Trainer	J00189	LA

General Provider Information

NPI Number	:	1477769362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHERYL MELISSA EAGLIN MED,MS,LAT

Provider Business Mailing Address
First Line	:	3201 RUE PARC FONTAINE
Second Line	:	APT. 3117
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-6960
Country	:	US
Telephone Number	:	504-813-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 RUE PARC FONTAINE
Second Line	:	APT. 3117
City	:	NEW ORLEANS
State	:	LA
Zip	:	70131-6960
Country	:	US
Telephone Number	:	504-813-6463
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	06/06/2013

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