Provider Demographics
NPI:1083314611
Name:PERSAUD, EVA MARIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26162 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-1505
Mailing Address - Country:US
Mailing Address - Phone:914-494-9822
Mailing Address - Fax:
Practice Address - Street 1:26162 TUSCANY DR
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-1505
Practice Address - Country:US
Practice Address - Phone:914-494-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-301919174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN