Healthcare Provider Details

I. General information

NPI: 1285031732
Provider Name (Legal Business Name): JILLIAN KERMANI R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 11/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CEDAR ST
SYRACUSE NY
13210-2302
US

IV. Provider business mailing address

131 CROYDEN LN APARTMENT F
SYRACUSE NY
13224-2131
US

V. Phone/Fax

Practice location:
  • Phone: 845-625-7472
  • Fax:
Mailing address:
  • Phone: 845-625-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number674947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: