Healthcare Provider Details

I. General information

NPI: 1467370098
Provider Name (Legal Business Name): ANNISHA C JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 OLD YORK RD STE 211
ELKINS PARK PA
19027-1426
US

IV. Provider business mailing address

8080 OLD YORK RD STE 211
ELKINS PARK PA
19027-1426
US

V. Phone/Fax

Practice location:
  • Phone: 215-594-3181
  • Fax:
Mailing address:
  • Phone: 215-594-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: