Provider Demographics
NPI:1295016806
Name:DYSON, AUNDREA F
Entity Type:Individual
Prefix:MISS
First Name:AUNDREA
Middle Name:F
Last Name:DYSON
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 1:7 SULTAN AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1952
Mailing Address - Country:US
Mailing Address - Phone:240-857-2333
Mailing Address - Fax:
Practice Address - Street 1:7 SULTAN AVE.
Practice Address - Street 2:
Practice Address - City:CAPITAL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743
Practice Address - Country:US
Practice Address - Phone:240-857-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians