Provider Demographics
NPI:1083259741
Name:SOLOMON, JASMINE ALEESHA (NP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALEESHA
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-3048
Mailing Address - Country:US
Mailing Address - Phone:716-598-0671
Mailing Address - Fax:
Practice Address - Street 1:5904 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5873
Practice Address - Country:US
Practice Address - Phone:716-886-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402876-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health