Provider Demographics
NPI:1336974898
Name:ELDER-ISADORE, EYANNA MONET
Entity type:Individual
Prefix:
First Name:EYANNA
Middle Name:MONET
Last Name:ELDER-ISADORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EYANNA
Other - Middle Name:MONET
Other - Last Name:ELDER-ISADORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:65 STIMENS DR APT 7
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-6506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 LARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2424
Practice Address - Country:US
Practice Address - Phone:419-747-4122
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
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician