Provider Demographics
NPI:1417613860
Name:TADDONIO, JODI (RN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:TADDONIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:VANSLYKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:74 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9518
Mailing Address - Country:US
Mailing Address - Phone:585-356-4255
Mailing Address - Fax:
Practice Address - Street 1:74 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:NY
Practice Address - Zip Code:14058-9518
Practice Address - Country:US
Practice Address - Phone:585-356-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse