Healthcare Provider Details

I. General information

NPI: 1699637173
Provider Name (Legal Business Name): PATRICIA DEDLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N WASHINGTON ST
HERKIMER NY
13350-1233
US

IV. Provider business mailing address

430 N WASHINGTON ST
HERKIMER NY
13350-1233
US

V. Phone/Fax

Practice location:
  • Phone: 315-219-7303
  • Fax:
Mailing address:
  • Phone: 315-219-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number004576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: