Provider Demographics
NPI:1982101549
Name:EDWARDS, SOYINI (CERT HAIR REP SPEC)
Entity Type:Individual
Prefix:
First Name:SOYINI
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CERT HAIR REP SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780D NEW HOLT RD STE 370
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7436
Mailing Address - Country:US
Mailing Address - Phone:213-270-3770
Mailing Address - Fax:
Practice Address - Street 1:2780D NEW HOLT RD STE 370
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7436
Practice Address - Country:US
Practice Address - Phone:213-270-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management