Provider Demographics
NPI:1447812987
Name:VITIELLO, JO ANNE
Entity type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:VITIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:NEW SUFFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:11956-0234
Mailing Address - Country:US
Mailing Address - Phone:631-901-2916
Mailing Address - Fax:
Practice Address - Street 1:430 OAK RD
Practice Address - Street 2:
Practice Address - City:NEW SUFFOLK
Practice Address - State:NY
Practice Address - Zip Code:11956-2090
Practice Address - Country:US
Practice Address - Phone:631-901-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer