Provider Demographics
NPI:1063740678
Name:EGGLETON, HADIJAH VANADA (LAC)
Entity type:Individual
Prefix:
First Name:HADIJAH
Middle Name:VANADA
Last Name:EGGLETON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HADIJAH
Other - Middle Name:SYLVIA VANADA
Other - Last Name:EGGLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:3939 HOLLYWOOD BLVD
Mailing Address - Street 2:MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6749
Mailing Address - Country:US
Mailing Address - Phone:954-272-6011
Mailing Address - Fax:954-272-6012
Practice Address - Street 1:3939 HOLLYWOOD BLVD
Practice Address - Street 2:MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6749
Practice Address - Country:US
Practice Address - Phone:954-272-6011
Practice Address - Fax:954-272-6012
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2589171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist