Healthcare Provider Details

I. General information

NPI: 1114858750
Provider Name (Legal Business Name): LAUREN MARIE JEDRYSIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REN JEDRYSIK

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 W GENESEE ST
SYRACUSE NY
13202-1100
US

IV. Provider business mailing address

5 RETTS RD
WHITESBORO NY
13492-3235
US

V. Phone/Fax

Practice location:
  • Phone: 518-350-4355
  • Fax:
Mailing address:
  • Phone: 315-520-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: