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General NPI Number Information
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NPI Number | 1629173992
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Entity Type | Individual
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Provider Name | MATTHEW JONATHAN EDLUND MD MOH
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 950 S TAMIAMI TRAIL SUITE 100
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City | SARASOTA
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State | FL
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Zip | 34236-7840
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Country | US
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Telephone | 941-365-4308
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Fax | 941-366-1199
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Provider Business Mailing Address
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Address Line | 950 S TAMIAMI TRAIL SUITE 100
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City | SARASOTA
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State | FL
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Zip | 34236-7840
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Country | US
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Telephone | 941-365-4308
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Fax | 941-366-1199
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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 | ME56856
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License Number State | FL
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