Healthcare Provider Details

I. General information

NPI: 1598630121
Provider Name (Legal Business Name): CHRISTIE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 W JERICHO TPKE
SMITHTOWN NY
11787-3208
US

IV. Provider business mailing address

103 EMILY AVE
ELMONT NY
11003-4223
US

V. Phone/Fax

Practice location:
  • Phone: 631-368-2583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: