Kiara Lynn Oddo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

100 Nicolls Road HSC T12 RM 080
Stony Brook, NY 11794

Phone

(631) 444-1116

Fax

(631) 444-1535

NPI assigned

May 8, 2022

Last updated

Aug 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kiara Lynn Blandeburgo Other name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• New York Spine & Brain Surgery, University Faculty Practice Corporatio

  • Neurological Surgery Physician
  • Stony Brook, NY
  • NPI 1154376309
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1215673710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NICOLLS ROAD HSC T12 RM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-774-1398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS ROAD HSC T12 RM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-444-1116",
            "fax_number": "631-444-1535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Cedar Ave",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "NY",
            "postal_code": "117633501",
            "country_code": "US",
            "telephone_number": "631-774-1398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODDO",
        "first_name": "KIARA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-08",
        "last_updated": "2024-08-15",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIARA",
            "last_name": "BLANDEBURGO",
            "middle_name": "LYNN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Meghan O'Neill, PA-C
• Neil Obeso, DPT
• Craig Peter Obrien, MFT
• William Ocampo
• Uchechi Ifeoma Oddiri, M.D.
• Nora A Odingo, DMD
• Jaymie Eureko Oentoro, M.D.
• Anthony Oganov
• Jonathan Ogulnick, MD
• Oladunni Ogundipe

• Physician Assistant in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.