Provider Demographics
NPI:1407298615
Name:SYETTA, JORDANA
Entity Type:Individual
Prefix:MS
First Name:JORDANA
Middle Name:
Last Name:SYETTA
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 1:134 SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3214
Mailing Address - Country:US
Mailing Address - Phone:718-948-6024
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH AVE STE LL2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3430
Practice Address - Country:US
Practice Address - Phone:718-477-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist