Provider Demographics
NPI:1134384357
Name:EDWARDS, TRACIE DAWN (HEARING AID SPECIALI)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:HEARING AID SPECIALI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 RT 417 WEST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:NY
Mailing Address - Zip Code:14715
Mailing Address - Country:US
Mailing Address - Phone:585-928-1657
Mailing Address - Fax:
Practice Address - Street 1:7760 ROUTE 417 W
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:NY
Practice Address - Zip Code:14715
Practice Address - Country:US
Practice Address - Phone:585-928-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15000016138237700000X
PAF03199237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF03199OtherHEARING AID DISPENSER
NY15000016138OtherHEARING AID DISPENSER