Provider Demographics
NPI:1093122616
Name:EADY, RASHAD
Entity Type:Individual
Prefix:
First Name:RASHAD
Middle Name:
Last Name:EADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 269
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2482
Mailing Address - Country:US
Mailing Address - Phone:510-435-7239
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 269
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2482
Practice Address - Country:US
Practice Address - Phone:510-435-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2695134172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker