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General NPI Number Information
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NPI Number | 1518622455
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Entity Type | Individual
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Provider Name | ANTONIO PEDULLA JR. CRNP
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Gender | Male
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 14 ROGERS RD STE 211
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City | NORTH EAST
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State | MD
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Zip | 21901-3612
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Country | US
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Telephone | 410-280-7683
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Fax | 610-702-8056
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Provider Business Mailing Address
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Address Line | 2207 CONCORD PIKE # 197
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City | WILMINGTON
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State | DE
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Zip | 19803-2908
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Country | US
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Telephone | 610-998-3902
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP024827
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN674446
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP027026
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License Number State | PA
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