Provider Demographics
NPI:1073785846
Name:PEDULLA, JUDY JEANNINE
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:JEANNINE
Last Name:PEDULLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NUTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3014
Mailing Address - Country:US
Mailing Address - Phone:330-633-8259
Mailing Address - Fax:
Practice Address - Street 1:73 NUTWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3014
Practice Address - Country:US
Practice Address - Phone:330-633-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL293107172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker