Provider Demographics
NPI:1992091557
Name:AMADEO, JASON PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:AMADEO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S CLEARVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1015
Mailing Address - Country:US
Mailing Address - Phone:504-736-4800
Mailing Address - Fax:504-736-4810
Practice Address - Street 1:1201 S CLEARVIEW PKWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1015
Practice Address - Country:US
Practice Address - Phone:504-736-4800
Practice Address - Fax:504-736-4810
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200450363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2165607Medicaid
LA5CQ60PF05Medicare PIN