MEDICARE: JACHELLE ELIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	331315-1	NY

General Provider Information

NPI Number	:	1114428521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACHELLE ELIAS

Provider Business Mailing Address
First Line	:	15131 81ST ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15131 81ST ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1735
Country	:	US
Telephone Number	:	929-462-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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Directions to “ JACHELLE ELIAS ” Practice Location

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