Provider Demographics
NPI:1427880624
Name:EBERHARDT, JUANIKA
Entity type:Individual
Prefix:
First Name:JUANIKA
Middle Name:
Last Name:EBERHARDT
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 1:4607 LIBRARY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-6909
Mailing Address - Country:US
Mailing Address - Phone:724-236-4227
Mailing Address - Fax:
Practice Address - Street 1:133 E WOODFORD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-4313
Practice Address - Country:US
Practice Address - Phone:724-236-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA78653601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1043678760001Medicaid