Provider Demographics
NPI:1275749798
Name:EREDITARIO, MONICA A (MS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:EREDITARIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 LOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2661
Mailing Address - Country:US
Mailing Address - Phone:724-527-2228
Mailing Address - Fax:
Practice Address - Street 1:802 LOWRY AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2661
Practice Address - Country:US
Practice Address - Phone:724-527-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000443L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208049Medicare ID - Type Unspecified