Provider Demographics
NPI:1689432353
Name:MOORE, EBONY EUNIQUE (DOULA)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:EUNIQUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MANHATTAN AVE APT 5J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1938
Mailing Address - Country:US
Mailing Address - Phone:929-578-8176
Mailing Address - Fax:
Practice Address - Street 1:410 MANHATTAN AVE APT 5J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1938
Practice Address - Country:US
Practice Address - Phone:929-578-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula