Provider Demographics
NPI:1184200115
Name:HANDYSIDE, EMILEE (DO)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:HANDYSIDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:
Other - Last Name:EBELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:223 REGALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8014
Mailing Address - Country:US
Mailing Address - Phone:724-766-4235
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-598-4122
Practice Address - Fax:304-598-4930
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program