MEDICARE: MS. EDDA A COLON MS/PHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1263	PR

General Provider Information

NPI Number	:	1104168087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDDA A COLON MS/PHL

Provider Business Mailing Address
First Line	:	URB. JARDINES C/9 L-11
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-1924
Country	:	US
Telephone Number	:	787-674-4020
Fax Number	:	787-592-1564

Provider Business Practice Location Address
First Line	:	CARR 153 KM 7.5 BO USERAS
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-2762
Country	:	US
Telephone Number	:	787-674-4020
Fax Number	:	787-592-1564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	01/06/2025

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Directions to “ MS. EDDA A COLON MS/PHL” Practice Location

Language	Start Address	Practice Location

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