Provider Demographics
NPI:1477854230
Name:EDWARDS, SOUNJA LIENASE
Entity Type:Individual
Prefix:MS
First Name:SOUNJA
Middle Name:LIENASE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOUNJA
Other - Middle Name:LIENASE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 19203
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-0203
Mailing Address - Country:US
Mailing Address - Phone:585-287-1561
Mailing Address - Fax:
Practice Address - Street 1:177 SAWYER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1946
Practice Address - Country:US
Practice Address - Phone:585-287-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-235202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse