Healthcare Provider Details

I. General information

NPI: 1285434084
Provider Name (Legal Business Name): JENNIFER VELONIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 SUTTON ST
CHARLESTON SC
29412-4037
US

IV. Provider business mailing address

1523 SUTTON ST
CHARLESTON SC
29412-4037
US

V. Phone/Fax

Practice location:
  • Phone: 978-590-8985
  • Fax:
Mailing address:
  • Phone: 978-590-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number271181
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: