Healthcare Provider Details

I. General information

NPI: 1710210745
Provider Name (Legal Business Name): NIAMH A CONDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST # L-17
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

653-1 W 8TH ST # L-17
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-2061
  • Fax:
Mailing address:
  • Phone: 904-244-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5315041797
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS016597
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberOS16257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: