Provider Demographics
NPI:1689184350
Name:EDWARDS, JAMARO (COSMOLOGISTS)
Entity type:Individual
Prefix:MS
First Name:JAMARO
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:COSMOLOGISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 PARK ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2237
Mailing Address - Country:US
Mailing Address - Phone:860-680-1074
Mailing Address - Fax:
Practice Address - Street 1:1477 PARK ST UNIT 105
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2237
Practice Address - Country:US
Practice Address - Phone:860-680-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1744P3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies