Provider Demographics
NPI:1134537731
Name:EDWARDS, TRUDI ANN
Entity type:Individual
Prefix:
First Name:TRUDI ANN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRUDI ANN
Other - Middle Name:
Other - Last Name:BYRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:462 S LONG BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5514
Mailing Address - Country:US
Mailing Address - Phone:516-642-7570
Mailing Address - Fax:
Practice Address - Street 1:462 S LONG BEACH AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5514
Practice Address - Country:US
Practice Address - Phone:516-642-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency