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General NPI Number Information
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NPI Number | 1023302502
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Entity Type | Individual
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Provider Name | DR. EDNA AURELUS
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Gender | Female
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 15 EBONY STREET
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City | STATEN ISLAND
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State | NY
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Zip | 10306-1922
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Country | US
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Telephone | 480-427-1430
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Fax |
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Provider Business Mailing Address
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Address Line | 15 EBONY ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-1922
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Country | US
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Telephone | 480-427-1430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | F40255301
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F3358321
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP4001
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License Number State | AZ
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