| Doctor Name: | MRS. SANDRA EDON |
| NPI Number: | 1154676120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 309789 |
| Business Practice Address: | 37 Doherty Ave Elmont, NY - 110032414 |
| Business Phone Number: | 5163520381 |
| Business Fax Number: | |
| Mailing Address: | 37 Doherty Ave, ELMONT |
| State: | NY |
| Postal Code: | 110032414 |
| Phone Number: | 5163520381 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2012 |
| NPI Last Update Date: | 07/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3140N1450X |
| License Number: | 309789 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Skilled Nursing Facility |
| Taxonomy Specialization: | Nursing Care, Pediatric |
| Taxonomy Definition: | A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |