Provider Demographics
NPI:1356732689
Name:ODDO, DANA MARIE
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:ODDO
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 1:29 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1759
Mailing Address - Country:US
Mailing Address - Phone:914-879-4462
Mailing Address - Fax:
Practice Address - Street 1:29 SPLIT ROCK RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1759
Practice Address - Country:US
Practice Address - Phone:914-879-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist