Provider Demographics
NPI:1255694113
Name:JENKINS-JORDAN, SHAUNTEL LATOYA
Entity Type:Individual
Prefix:MRS
First Name:SHAUNTEL
Middle Name:LATOYA
Last Name:JENKINS-JORDAN
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 1:15544 116TH DR
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1514
Mailing Address - Country:US
Mailing Address - Phone:718-749-4628
Mailing Address - Fax:
Practice Address - Street 1:15544 116TH DR
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1514
Practice Address - Country:US
Practice Address - Phone:718-749-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist