Provider Demographics
NPI:1265267892
Name:PERALTA-AMEL, EDDY
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:PERALTA-AMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHAPE DC-AVENUE D'OSLO BLDG 401, ROOM 2C119
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SHAPE DC-AVENUE D'OSLO BLDG 401, ROOM 2C119
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705-5000
Practice Address - Country:US
Practice Address - Phone:314-566-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist