Provider Demographics
NPI:1144005786
Name:BORODIN, MADYSON ERYN
Entity type:Individual
Prefix:
First Name:MADYSON
Middle Name:ERYN
Last Name:BORODIN
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 1:2974 RIDINGS WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4273
Mailing Address - Country:US
Mailing Address - Phone:443-866-7956
Mailing Address - Fax:
Practice Address - Street 1:2400 KINGSTON CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3650
Practice Address - Country:US
Practice Address - Phone:717-755-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist