Provider Demographics
NPI:1295205904
Name:BAILEY, JAD SHELDON
Entity Type:Individual
Prefix:
First Name:JAD
Middle Name:SHELDON
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95378-0296
Mailing Address - Country:US
Mailing Address - Phone:415-297-4034
Mailing Address - Fax:
Practice Address - Street 1:3150 ROCHAMBEAU AVE APT L1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-0783
Practice Address - Country:US
Practice Address - Phone:929-368-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician