Provider Demographics
NPI:1710741475
Name:MATTHEWS, EESHAWNNA
Entity Type:Individual
Prefix:
First Name:EESHAWNNA
Middle Name:
Last Name:MATTHEWS
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 1:2734 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-4033
Mailing Address - Country:US
Mailing Address - Phone:850-933-6069
Mailing Address - Fax:
Practice Address - Street 1:1504 SE 21ST ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4612
Practice Address - Country:US
Practice Address - Phone:850-933-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services