MEDICARE: MS. LONDA LEE B.A., M.A.

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	174H00000X	Health Educator		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	931835761	OTHER	NY	GHI

General Provider Information

NPI Number	:	1306220470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LONDA LEE B.A., M.A.

Provider Business Mailing Address
First Line	:	234 SPENCER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4544
Country	:	US
Telephone Number	:	718-938-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 SPENCER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4544
Country	:	US
Telephone Number	:	718-938-8079
Fax Number	:

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

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	07/17/2015

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