Provider Demographics
NPI:1164023925
Name:DAVID, EDDY
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:DAVID
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 1:1118 GRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6724
Mailing Address - Country:US
Mailing Address - Phone:407-701-3014
Mailing Address - Fax:
Practice Address - Street 1:1118 GRAYSON DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6724
Practice Address - Country:US
Practice Address - Phone:407-701-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator