Healthcare Provider Details

I. General information

NPI: 1447169982
Provider Name (Legal Business Name): MARTIN JENKINS AMODEI JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 RED WING LN
DOVER PA
17315-2785
US

IV. Provider business mailing address

1810 RED WING LN
DOVER PA
17315-2785
US

V. Phone/Fax

Practice location:
  • Phone: 717-586-8859
  • Fax:
Mailing address:
  • Phone: 717-586-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033767
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: