Healthcare Provider Details

I. General information

NPI: 1013843507
Provider Name (Legal Business Name): JACQUELIN JUSTINE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SOUTHERN BLVD APT 4C
BRONX NY
10455-3656
US

IV. Provider business mailing address

660 SOUTHERN BLVD APT 4C
BRONX NY
10455-3656
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-3619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: