Healthcare Provider Details

I. General information

NPI: 1992557771
Provider Name (Legal Business Name): JODI-ANN SEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

11747 196TH ST
SAINT ALBANS NY
11412-3449
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: