Provider Demographics
NPI:1659784999
Name:EASTERDAY, CARLY
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:EASTERDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 CYPRESS GREEN DR
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2013
Mailing Address - Country:US
Mailing Address - Phone:904-647-1849
Mailing Address - Fax:
Practice Address - Street 1:9141 CYPRESS GREEN DR
Practice Address - Street 2:SUITE # 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2013
Practice Address - Country:US
Practice Address - Phone:904-647-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist