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General NPI Number Information
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NPI Number | 1518498633
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Entity Type | Individual
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Provider Name | JENNIFER SZELISTOWSKI DO
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Gender | Female
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 100 N ACADEMY AVE DEPT OF INTERNAL MEDICINE
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City | DANVILLE
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State | PA
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Zip | 17822-9800
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Country | US
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Telephone | 610-914-3038
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Fax |
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Provider Business Mailing Address
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Address Line | 250 DEWEY AVE
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City | SPARTANBURG
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State | SC
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Zip | 29303-3009
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 83710
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License Number State | SC
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