MEDICARE: MRS. AUDREY LUNDY

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	104100000X	Social Worker	SW140103	PA

General Provider Information

NPI Number	:	1790465805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDREY LUNDY

Provider Business Mailing Address
First Line	:	5403 TACKAWANNA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-1410
Country	:	US
Telephone Number	:	862-596-2712
Fax Number	:

Provider Business Practice Location Address
First Line	:	5403 TACKAWANNA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-1410
Country	:	US
Telephone Number	:	862-596-2712
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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