Healthcare Provider Details

I. General information

NPI: 1699694331
Provider Name (Legal Business Name): SULLY REINOSO JARAMILLO M.S PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WISCONSIN AVENUE
BRENTWOOD NY
11717
US

IV. Provider business mailing address

14736 94TH AVE APT 19O
JAMAICA NY
11435-4561
US

V. Phone/Fax

Practice location:
  • Phone: 646-434-2401
  • Fax:
Mailing address:
  • Phone: 347-567-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: