Healthcare Provider Details

I. General information

NPI: 1629330246
Provider Name (Legal Business Name): GLENDA GLOUDON-DYER MSC.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 06/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7803 151ST AVE
HOWARD BEACH NY
11414-1102
US

IV. Provider business mailing address

7803 151ST AVE
HOWARD BEACH NY
11414-1102
US

V. Phone/Fax

Practice location:
  • Phone: 347-870-9415
  • Fax:
Mailing address:
  • Phone: 347-870-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number001181001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: