Provider Demographics
NPI:1083979652
Name:ELIADI, CAROL ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:ELIADI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 FARMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6201
Mailing Address - Country:US
Mailing Address - Phone:508-842-9849
Mailing Address - Fax:
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1823
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110010251J00000X
MARN110010363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251J00000XAgenciesNursing Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health