Healthcare Provider Details

I. General information

NPI: 1427608793
Provider Name (Legal Business Name): THERESA T EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. THERESA T EDWARDS

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 OLD CEDARBROOK RD
WYNCOTE PA
19095-2039
US

IV. Provider business mailing address

44 OLD CEDARBROOK RD
WYNCOTE PA
19095-2039
US

V. Phone/Fax

Practice location:
  • Phone: 407-580-9466
  • Fax: 215-242-2456
Mailing address:
  • Phone: 407-580-9466
  • Fax: 215-242-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number43373601
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: