Healthcare Provider Details

I. General information

NPI: 1437578564
Provider Name (Legal Business Name): JENNA FELICI-WEST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 MENCHACA RD
AUSTIN TX
78704-6746
US

IV. Provider business mailing address

134 N 4TH ST
BROOKLYN NY
11249-3296
US

V. Phone/Fax

Practice location:
  • Phone: 512-982-4116
  • Fax: 512-265-9008
Mailing address:
  • Phone: 464-450-7748
  • Fax: 718-481-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.163422
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: