Provider Demographics
NPI:1952902546
Name:EDENBURGH, FLOYD
Entity Type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:
Last Name:EDENBURGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 CHELTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5065
Mailing Address - Country:US
Mailing Address - Phone:216-450-8090
Mailing Address - Fax:
Practice Address - Street 1:3663 CHELTON RD
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5065
Practice Address - Country:US
Practice Address - Phone:216-450-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC363452347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSC363452Medicaid