Provider Demographics
NPI:1154797314
Name:ABRAHAMSON, ODELYA
Entity type:Individual
Prefix:MRS
First Name:ODELYA
Middle Name:
Last Name:ABRAHAMSON
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 1:14432 75TH RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2427
Mailing Address - Country:US
Mailing Address - Phone:347-419-2857
Mailing Address - Fax:
Practice Address - Street 1:14432 75TH RD APT 2C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2427
Practice Address - Country:US
Practice Address - Phone:347-419-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640577121390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program