MEDICARE: ASHLEY NICOLE ODDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F353652-01	NY

General Provider Information

NPI Number	:	1184432627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE ODDO

Provider Business Mailing Address
First Line	:	835 SHELDON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 SHELDON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2437
Country	:	US
Telephone Number	:	917-921-6090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	08/15/2025

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Directions to “ ASHLEY NICOLE ODDO ” Practice Location

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