Provider Demographics
NPI:1598710451
Name:GEDNEY, JEFFREY J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:GEDNEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-0326
Mailing Address - Country:US
Mailing Address - Phone:808-747-5435
Mailing Address - Fax:866-384-4779
Practice Address - Street 1:45-547 PLUMERIA ST
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6902
Practice Address - Country:US
Practice Address - Phone:808-747-5435
Practice Address - Fax:808-441-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-6767103TC0700X
HIPSY1374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9478Medicare ID - Type UnspecifiedPSYCHOLOGIST
FL73136ZMedicare PIN