Healthcare Provider Details

I. General information

NPI: 1861948531
Provider Name (Legal Business Name): JASMINE NICOLE PRYOR MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 ROUTE 31 BOX 10 SUITE 7
CICERO NY
13039
US

IV. Provider business mailing address

121 LAFAYETTE RD APT 524
SYRACUSE NY
13205-2929
US

V. Phone/Fax

Practice location:
  • Phone: 315-698-0033
  • Fax: 315-698-0031
Mailing address:
  • Phone: 315-870-2994
  • Fax: 315-698-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: