Healthcare Provider Details

I. General information

NPI: 1902634223
Provider Name (Legal Business Name): JAQUELINE SERWAA WIAFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 NEPTUNE BLVD
NEPTUNE NJ
07753-4144
US

IV. Provider business mailing address

444 NEPTUNE BLVD UNIT 1
NEPTUNE NJ
07753-4144
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-1700
  • Fax:
Mailing address:
  • Phone: 732-775-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00131800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: