Provider Demographics
NPI:1508120361
Name:JEDRYSIK, THERESA M (MS, SPE ED)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:JEDRYSIK
Suffix:
Gender:F
Credentials:MS, SPE ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RETTS RD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3235
Mailing Address - Country:US
Mailing Address - Phone:315-736-1663
Mailing Address - Fax:
Practice Address - Street 1:5 RETTS RD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-3235
Practice Address - Country:US
Practice Address - Phone:315-736-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist