Provider Demographics
NPI:1669703310
Name:ODDO, JAIME L
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:ODDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:ODDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:17 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3640
Mailing Address - Country:US
Mailing Address - Phone:631-703-1639
Mailing Address - Fax:
Practice Address - Street 1:14 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1857
Practice Address - Country:US
Practice Address - Phone:631-703-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614116-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse