MEDICARE: IANUA HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093559304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IANUA HEALTH, LLC

Provider Business Mailing Address
First Line	:	14 ROGERS RD STE 211
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-3612
Country	:	US
Telephone Number	:	410-280-7683
Fax Number	:	610-702-8056

Provider Business Practice Location Address
First Line	:	14 ROGERS RD STE 211
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-3612
Country	:	US
Telephone Number	:	410-280-7683
Fax Number	:	610-702-8056

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	MR. ANTONIO PEDULLA JR.
Credential	:	CRNP
Telephone Number	:	610-998-3902

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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Directions to “IANUA HEALTH, LLC ” Practice Location

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