Provider Demographics
NPI:1952819500
Name:FELICE, JJODY (RN)
Entity Type:Individual
Prefix:
First Name:JJODY
Middle Name:
Last Name:FELICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DOLPHIN LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-6200
Mailing Address - Country:US
Mailing Address - Phone:631-766-5189
Mailing Address - Fax:
Practice Address - Street 1:107 DOLPHIN LN
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-6200
Practice Address - Country:US
Practice Address - Phone:631-766-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303446-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6317665189Medicaid