Provider Demographics
NPI:1235804980
Name:VELAZQUEZ, JESSICA LAUREN (MA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LAUREN
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2331
Mailing Address - Country:US
Mailing Address - Phone:516-557-3200
Mailing Address - Fax:
Practice Address - Street 1:25 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2331
Practice Address - Country:US
Practice Address - Phone:516-557-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist