Provider Demographics
NPI:1225757354
Name:EADY, SHAMARI
Entity Type:Individual
Prefix:MS
First Name:SHAMARI
Middle Name:
Last Name:EADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAMARI
Other - Middle Name:DAJA
Other - Last Name:EADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18490 JOHNSON ST UNIT EFGH
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3699
Mailing Address - Country:US
Mailing Address - Phone:754-264-8779
Mailing Address - Fax:
Practice Address - Street 1:18490 JOHNSON ST UNIT EFGH
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3699
Practice Address - Country:US
Practice Address - Phone:754-264-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician