Healthcare Provider Details

I. General information

NPI: 1841729233
Provider Name (Legal Business Name): JENDY AMELIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/07/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYNE-JONES ARMY COMMUNITY HOSPITAL 1585 THIRD ST
FORT JOHNSON LA
71459
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
JBSA FT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 760-500-2943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31145
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: