Provider Demographics
NPI:1871239509
Name:AMODEUS HEALTHCARE & PSYCHIATRY SVS LLC
Entity type:Organization
Organization Name:AMODEUS HEALTHCARE & PSYCHIATRY SVS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SLYNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP
Authorized Official - Phone:603-305-7076
Mailing Address - Street 1:75 GILCREAST RD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3566
Mailing Address - Country:US
Mailing Address - Phone:603-305-7076
Mailing Address - Fax:888-271-7687
Practice Address - Street 1:75 GILCREAST RD UNIT 210
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3566
Practice Address - Country:US
Practice Address - Phone:603-305-7076
Practice Address - Fax:888-271-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Multi-Specialty