Provider Demographics
NPI:1023152436
Name:BEDSAUL, TRINA RENEE (AUD)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:RENEE
Last Name:BEDSAUL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 BETHESDA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3301
Mailing Address - Country:US
Mailing Address - Phone:336-774-1113
Mailing Address - Fax:336-774-1467
Practice Address - Street 1:751 BETHESDA RD STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3301
Practice Address - Country:US
Practice Address - Phone:336-774-1113
Practice Address - Fax:336-774-1467
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC690237700000X
NC2601231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412001Medicaid
NC2601OtherSTATE AUDIOLOGY LICENSE #
NC14349OtherBLUE CROSS BLUE SHIELD #