Provider Demographics
NPI:1851098677
Name:GERALD, FEDNA JUSTINE
Entity type:Individual
Prefix:MS
First Name:FEDNA
Middle Name:JUSTINE
Last Name:GERALD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 KNOLLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1525
Mailing Address - Country:US
Mailing Address - Phone:216-260-1405
Mailing Address - Fax:330-632-8823
Practice Address - Street 1:9500 HOWLAND SPRINGS RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3108
Practice Address - Country:US
Practice Address - Phone:216-260-1405
Practice Address - Fax:330-632-8823
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2403807-TRNE104100000X
374U00000X
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374U00000XNursing Service Related ProvidersHome Health Aide