MEDICARE: JAD SHELDON BAILEY

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	374700000X	Technician

General Provider Information

NPI Number	:	1295205904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAD SHELDON BAILEY

Provider Business Mailing Address
First Line	:	PO BOX 296
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95378-0296
Country	:	US
Telephone Number	:	415-297-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 ROCHAMBEAU AVE APT L1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-0783
Country	:	US
Telephone Number	:	929-368-1829
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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Directions to “ JAD SHELDON BAILEY ” Practice Location

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