Healthcare Provider Details

I. General information

NPI: 1336044411
Provider Name (Legal Business Name): JIZELLE CHRISTINE AMIYAH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 256TH ST
FLORAL PARK NY
11001-1001
US

IV. Provider business mailing address

8435 256TH ST
FLORAL PARK NY
11001-1001
US

V. Phone/Fax

Practice location:
  • Phone: 347-487-6789
  • Fax: 626-626-7586
Mailing address:
  • Phone: 347-487-6789
  • Fax: 626-626-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: