Healthcare Provider Details

I. General information

NPI: 1821984865
Provider Name (Legal Business Name): JESSICA WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 61ST ST
BROOKLYN NY
11204-2110
US

IV. Provider business mailing address

1649 61ST ST
BROOKLYN NY
11204-2110
US

V. Phone/Fax

Practice location:
  • Phone: 212-481-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: