Provider Demographics
NPI:1225754732
Name:SANON-NEPTUNE, ODMENE (FNP)
Entity Type:Individual
Prefix:
First Name:ODMENE
Middle Name:
Last Name:SANON-NEPTUNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ODMENE
Other - Middle Name:
Other - Last Name:SANON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:11414 167TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1216
Mailing Address - Country:US
Mailing Address - Phone:646-600-2094
Mailing Address - Fax:
Practice Address - Street 1:8812 QUEENS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4489
Practice Address - Country:US
Practice Address - Phone:718-280-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily