Provider Demographics
NPI:1912086083
Name:ODONNELL, AMY M (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W MAIN ST
Mailing Address - Street 2:SUITE 255
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4543
Mailing Address - Country:US
Mailing Address - Phone:203-388-8735
Mailing Address - Fax:475-619-9014
Practice Address - Street 1:2001 W MAIN ST
Practice Address - Street 2:SUITE 100D
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-487-0285
Practice Address - Fax:203-487-0355
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT00399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22141Medicare UPIN