Provider Demographics
NPI:1083199640
Name:HYLAND, EDRISA
Entity Type:Individual
Prefix:
First Name:EDRISA
Middle Name:
Last Name:HYLAND
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 1:1828 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1839
Mailing Address - Country:US
Mailing Address - Phone:844-753-3673
Mailing Address - Fax:866-388-1939
Practice Address - Street 1:6523 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2753
Practice Address - Country:US
Practice Address - Phone:844-753-3673
Practice Address - Fax:866-388-1939
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA38593601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care