MEDICARE: TRUDI ANN EDWARDS

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	252Y00000X	Early Intervention Provider Agency		NY

General Provider Information

NPI Number	:	1134537731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUDI ANN EDWARDS

Provider Business Mailing Address
First Line	:	462 S LONG BEACH AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-5514
Country	:	US
Telephone Number	:	516-642-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 S LONG BEACH AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-5514
Country	:	US
Telephone Number	:	516-642-7570
Fax Number	:

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

Provider Enumeration Date	:	07/27/2014
Last Update Date	:	07/27/2014

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Directions to “ TRUDI ANN EDWARDS ” Practice Location

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