Provider Demographics
NPI:1184718504
Name:STAR, JODI ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:ELLEN
Last Name:STAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:STE 210
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449
Mailing Address - Country:US
Mailing Address - Phone:561-422-3314
Mailing Address - Fax:561-422-3315
Practice Address - Street 1:GUIDING LIGHT WELLNESS CENTER
Practice Address - Street 2:3319 STATE ROAD 7 STE 210
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449
Practice Address - Country:US
Practice Address - Phone:561-422-3314
Practice Address - Fax:561-422-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 85603208000000X, 2084P0804X, 2084P0800X
FLME856032084P0015X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry