Healthcare Provider Details

I. General information

NPI: 1952227878
Provider Name (Legal Business Name): JAILYN REIS SULLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14611 W CENTER RD
OMAHA NE
68144-3219
US

IV. Provider business mailing address

420 W 10TH ST
SCHUYLER NE
68661-2020
US

V. Phone/Fax

Practice location:
  • Phone: 402-275-4124
  • Fax:
Mailing address:
  • Phone: 402-370-0424
  • Fax: 402-370-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: