Individual
MA FIDES JAMELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 562-0100
Mailing address
PO BOX 3504, NEW HYDE PARK, NY 11040-8504
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F432131-01
NY
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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