MEDICARE: JIMYA SWEET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1821773896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMYA SWEET

Provider Business Mailing Address
First Line	:	4991 PARKSIDE AVE N APT 31
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4991 PARKSIDE AVE N APT 31
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2525
Country	:	US
Telephone Number	:	267-465-2793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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Directions to “ JIMYA SWEET ” Practice Location

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