Individual
DR. EDNA AURELUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 EBONY STREET, STATEN ISLAND, NY 10306-1922
(480) 427-1430
Mailing address
15 EBONY ST, STATEN ISLAND, NY 10306-1922
(480) 427-1430
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
F40255301
NY
363LF0000X
Family Nurse Practitioner
Primary
AP4001
AZ
363LF0000X
Family Nurse Practitioner
F3358321
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454798231
—
NY
Enumeration date
06/02/2011
Last updated
02/15/2022
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