Healthcare Provider Details

I. General information

NPI: 1669185765
Provider Name (Legal Business Name): JENNIFFER MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FISHER CT
WHITE PLAINS NY
10601-4135
US

IV. Provider business mailing address

11 FISHER CT APT 4F
WHITE PLAINS NY
10601-4121
US

V. Phone/Fax

Practice location:
  • Phone: 914-817-8078
  • Fax:
Mailing address:
  • Phone: 914-817-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number405055996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: