Active NPI
Edward Sedory, ATC, EMT
- Athletic Trainer
- Quantico, VA
National Provider Identifier
1710126685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126000778
- Practice address
- 24164 Montezuma Ave
The Basic School - S3/ Atr
Quantico, VA 22134-5123 - Phone
- (703) 784-6558
- NPI assigned
- Feb 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | B061117703 | VA | |
| Athletic Trainer | 2255A2300X | 0126000778 | VA | Primary |
Addresses
Primary practice location
24164 Montezuma Ave
The Basic School - S3/ Atr
Quantico, VA 22134-5123
Mailing address
3713 Alberta Dr
Fredericksburg, VA 22408-7714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B061117703 | VA | MD | Basic Emergency Medical Technician |
| 0126000778 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234742400000",
"number": "1710126685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3713 ALBERTA DR",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224087714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24164 MONTEZUMA AVE",
"address_2": "THE BASIC SCHOOL - S3/ ATR",
"city": "QUANTICO",
"state": "VA",
"postal_code": "221345123",
"telephone_number": "703-784-6558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEDORY",
"first_name": "EDWARD",
"credential": "ATC, EMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-16",
"last_updated": "2009-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "VA",
"license": "B061117703",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126000778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quantico, VA
- Michael Angel Santana, SFIDC
- Caitlin Ann Nolan Saroka
- Samantha Marie Schiro, PSYD
- Elle Marie Schollnberger, MD
- Anna Marie Sedory, MS, ATC, CSCS
- Christopher George Sellers, D.M.D.
- Mary Shelton Graessle, PA
- Nancy Sachie Shinozuka-Johnson, AGPCNP-BC
- David Lee Shiveley, M.D., M.P.H.
- Charles Simerman, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.