Healthcare Provider Details

I. General information

NPI: 1871239509
Provider Name (Legal Business Name): AMODEUS HEALTHCARE & PSYCHIATRY SVS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GILCREAST RD UNIT 210
LONDONDERRY NH
03053-3566
US

IV. Provider business mailing address

75 GILCREAST RD UNIT 210
LONDONDERRY NH
03053-3566
US

V. Phone/Fax

Practice location:
  • Phone: 603-305-7076
  • Fax: 888-271-7687
Mailing address:
  • Phone: 603-305-7076
  • Fax: 888-271-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: TAI SLYNE
Title or Position: PROVIDER
Credential: APRN, DNP
Phone: 603-305-7076