Provider Demographics
NPI:1235997420
Name:JEFFRIES, NANDI
Entity Type:Individual
Prefix:
First Name:NANDI
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E PATH RISE
Mailing Address - Street 2:
Mailing Address - City:W HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-8601
Mailing Address - Country:US
Mailing Address - Phone:585-512-5407
Mailing Address - Fax:
Practice Address - Street 1:123 E PATH RISE
Practice Address - Street 2:
Practice Address - City:W HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-8601
Practice Address - Country:US
Practice Address - Phone:585-512-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011528-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant