Provider Demographics
NPI:1093307753
Name:MEREDITH, JADA (SF)
Entity Type:Individual
Prefix:MISS
First Name:JADA
Middle Name:
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:SF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WINDSOR CASTLE DR APT H
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1963
Mailing Address - Country:US
Mailing Address - Phone:757-510-2469
Mailing Address - Fax:
Practice Address - Street 1:153 WINDSOR CASTLE DR APT H
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1963
Practice Address - Country:US
Practice Address - Phone:757-510-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management