Healthcare Provider Details

I. General information

NPI: 1124274048
Provider Name (Legal Business Name): TENESA RIVERA JEFFRESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W. 6TH STREET 303
MEDIA PA
19063
US

IV. Provider business mailing address

100 W SIXTH ST STE 303
MEDIA PA
19063-2428
US

V. Phone/Fax

Practice location:
  • Phone: 484-393-5626
  • Fax:
Mailing address:
  • Phone: 484-393-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD442958
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD442958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: