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General NPI Number Information
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NPI Number | 1871302901
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Entity Type | Individual
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Provider Name | JAMILAH DA COSTA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 14410 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11435-3624
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Country | US
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Telephone | 718-206-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 9711 HORACE HARDING EXPY APT 3J
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City | CORONA
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State | NY
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Zip | 11368-4704
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Country | US
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Telephone |
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 859983
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 859983
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License Number State | NY
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