Healthcare Provider Details

I. General information

NPI: 1619802519
Provider Name (Legal Business Name): JAZELLE AMAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 BLUE POINT AVE
BLUE POINT NY
11715-1224
US

IV. Provider business mailing address

32 CRANBERRY ST
CENTRAL ISLIP NY
11722-4904
US

V. Phone/Fax

Practice location:
  • Phone: 866-794-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number981082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: