Healthcare Provider Details

I. General information

NPI: 1801223045
Provider Name (Legal Business Name): JHEANELLE NEWBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 GRACE AVE
BRONX NY
10466-1817
US

IV. Provider business mailing address

4315 GRACE AVE
BRONX NY
10466-1817
US

V. Phone/Fax

Practice location:
  • Phone: 929-266-7434
  • Fax:
Mailing address:
  • Phone: 929-266-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN23820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: