Individual
JO ANNE VITIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
430 OAK RD, NEW SUFFOLK, NY 11956-2090
(631) 901-2916
Mailing address
PO BOX 234, NEW SUFFOLK, NY 11956-0234
(631) 901-2916
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/04/2019
Last updated
07/04/2019
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