Provider Demographics
NPI:1558723288
Name:SUGZDINIS, EDMUND DEFOREST JR (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:DEFOREST
Last Name:SUGZDINIS
Suffix:JR
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 S ROCKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3228
Mailing Address - Country:US
Mailing Address - Phone:302-229-5216
Mailing Address - Fax:
Practice Address - Street 1:3407 S ROCKFIELD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3228
Practice Address - Country:US
Practice Address - Phone:302-229-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE03-202237700000X
PAF03241237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist