MEDICARE: ERENIA REDHEAD

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	023637-1	NY

General Provider Information

NPI Number	:	1417491853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERENIA REDHEAD

Provider Business Mailing Address
First Line	:	1740 E 52ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 WILLOUGHBY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-6815
Country	:	US
Telephone Number	:	718-387-0375
Fax Number	:

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

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	10/08/2020

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Directions to “ ERENIA REDHEAD ” Practice Location

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