Provider Demographics
NPI:1932396124
Name:AMODEO, DANA M (DO)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:AMODEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:AMODEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:135 WICKS RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4420
Mailing Address - Country:US
Mailing Address - Phone:516-428-2787
Mailing Address - Fax:
Practice Address - Street 1:135 WICKS RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4420
Practice Address - Country:US
Practice Address - Phone:516-428-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY252523-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine