Healthcare Provider Details

I. General information

NPI: 1689539082
Provider Name (Legal Business Name): JAMAICA LASHAUN AMPONSEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 DEVOE AVE UNIT 473
BRONX NY
10460-9448
US

IV. Provider business mailing address

1404 CREEK ST
COPPERAS COVE TX
76522-4741
US

V. Phone/Fax

Practice location:
  • Phone: 254-415-5447
  • Fax:
Mailing address:
  • Phone: 254-415-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: