Provider Demographics
NPI:1922750876
Name:WADDELL, JANET
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:WADDELL
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 1:526 47TH RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5558
Mailing Address - Country:US
Mailing Address - Phone:917-359-8279
Mailing Address - Fax:
Practice Address - Street 1:160 MADISON AVE STE 37
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5412
Practice Address - Country:US
Practice Address - Phone:917-359-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22WA1100008