Healthcare Provider Details

I. General information

NPI: 1972758027
Provider Name (Legal Business Name): JARED & JAEDEN MAKING A DIFFERENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 GERRY ST APT 4D
BROOKLYN NY
11206-5862
US

IV. Provider business mailing address

106 GERRY ST APT 4D
BROOKLYN NY
11206-5862
US

V. Phone/Fax

Practice location:
  • Phone: 929-675-2915
  • Fax: 347-889-7532
Mailing address:
  • Phone: 929-675-2915
  • Fax: 347-889-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number049877-1
License Number StateNY

VIII. Authorized Official

Name: SHARON ROSE NUNEZ
Title or Position: CEO
Credential:
Phone: 929-675-2915