Provider Demographics
NPI:1285368456
Name:PANTRY, JODIANN (EDD)
Entity type:Individual
Prefix:DR
First Name:JODIANN
Middle Name:
Last Name:PANTRY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAUREL RD E
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5708
Mailing Address - Country:US
Mailing Address - Phone:718-600-7437
Mailing Address - Fax:
Practice Address - Street 1:17 LAUREL RD E
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-5708
Practice Address - Country:US
Practice Address - Phone:718-600-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst