Provider Demographics
NPI:1780235937
Name:EDMOND, SHUNDALON DEMETRIC (MA)
Entity type:Individual
Prefix:MISS
First Name:SHUNDALON
Middle Name:DEMETRIC
Last Name:EDMOND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 COMMERCE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3883
Mailing Address - Country:US
Mailing Address - Phone:661-942-9135
Mailing Address - Fax:
Practice Address - Street 1:624 COMMERCE AVE STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3883
Practice Address - Country:US
Practice Address - Phone:661-942-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst