Provider Demographics
NPI:1023486263
Name:ODINAMMADU, JOY C (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:C
Last Name:ODINAMMADU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BALLYMENA CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2452
Mailing Address - Country:US
Mailing Address - Phone:443-739-7947
Mailing Address - Fax:
Practice Address - Street 1:6400 BALTIMORE NATIONAL PIKE STE 170A
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3900
Practice Address - Country:US
Practice Address - Phone:443-739-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR119113363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health