Provider Demographics
NPI:1730309626
Name:SOLOMON, ELDRA PEARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELDRA
Middle Name:PEARL
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S FIELDING AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2224
Mailing Address - Country:US
Mailing Address - Phone:813-250-0224
Mailing Address - Fax:813-250-9019
Practice Address - Street 1:309 S FIELDING AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2224
Practice Address - Country:US
Practice Address - Phone:813-250-0224
Practice Address - Fax:813-250-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73719Medicare ID - Type Unspecified