Healthcare Provider Details

I. General information

NPI: 1982965364
Provider Name (Legal Business Name): JOSEPH A O'DONNELL RN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

8461 RIVER RD
BALDWINSVILLE NY
13027-9223
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5111
  • Fax:
Mailing address:
  • Phone: 315-350-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number537578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: