Provider Demographics
NPI:1669817698
Name:BODDIN, AVON D (SPECIAL EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:AVON
Middle Name:D
Last Name:BODDIN
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:MS
Other - First Name:AVON
Other - Middle Name:D
Other - Last Name:BODDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SPECIAL EDUCATION
Mailing Address - Street 1:8848 78TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2310
Mailing Address - Country:US
Mailing Address - Phone:718-296-8810
Mailing Address - Fax:
Practice Address - Street 1:88-48 78 STREET
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:718-296-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693099121174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator