Provider Demographics
NPI:1164113429
Name:EDMONDS, SEAUN DANIEL SR (MS)
Entity Type:Individual
Prefix:MR
First Name:SEAUN
Middle Name:DANIEL
Last Name:EDMONDS
Suffix:SR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. ESTRELLA PARKWAY STE. B2 #453
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338
Mailing Address - Country:US
Mailing Address - Phone:480-375-5556
Mailing Address - Fax:
Practice Address - Street 1:3082 N. 53RD AVE. STE #260
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-8539
Practice Address - Country:US
Practice Address - Phone:480-375-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator