Provider Demographics
NPI:1871124628
Name:EADY, SALLY RUTH III
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:RUTH
Last Name:EADY
Suffix:III
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 1:2515 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3219
Mailing Address - Country:US
Mailing Address - Phone:202-352-5160
Mailing Address - Fax:
Practice Address - Street 1:2515 ALABAMA AVE SE # E.405
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3219
Practice Address - Country:US
Practice Address - Phone:202-262-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant