Provider Demographics
NPI:1568173664
Name:EADDY, STARR L (PHD, MSN, RN)
Entity Type:Individual
Prefix:DR
First Name:STARR
Middle Name:L
Last Name:EADDY
Suffix:
Gender:F
Credentials:PHD, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1603
Mailing Address - Country:US
Mailing Address - Phone:646-602-8237
Mailing Address - Fax:
Practice Address - Street 1:215 PARK AVE S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1603
Practice Address - Country:US
Practice Address - Phone:646-602-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666934163W00000X
NY350949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse