Provider Demographics
NPI:1104345768
Name:HEDGES, TONI LEE
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:LEE
Last Name:HEDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 OLD ROUTE 209
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5922
Mailing Address - Country:US
Mailing Address - Phone:845-399-8378
Mailing Address - Fax:
Practice Address - Street 1:375 OLD ROUTE 209
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443-5922
Practice Address - Country:US
Practice Address - Phone:845-399-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038795-1171M00000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator