Provider Demographics
NPI:1225167190
Name:SURRENA, EDWARD EUGENE JR (STP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:EUGENE
Last Name:SURRENA
Suffix:JR
Gender:M
Credentials:STP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 SALTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-3033
Mailing Address - Country:US
Mailing Address - Phone:412-798-8000
Mailing Address - Fax:
Practice Address - Street 1:5360 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3033
Practice Address - Country:US
Practice Address - Phone:412-798-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist