Healthcare Provider Details

I. General information

NPI: 1144923236
Provider Name (Legal Business Name): TENNYSON JELLINS MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH ST
SACRAMENTO CA
95817-1514
US

IV. Provider business mailing address

4501 X ST
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax:
Mailing address:
  • Phone: 916-734-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA210186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: