Provider Demographics
NPI:1497400675
Name:LEVINE, JORDANA MELISSA
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:MELISSA
Last Name:LEVINE
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 1:1334 CAFFREY AVE APT 4J
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5130
Mailing Address - Country:US
Mailing Address - Phone:347-617-9459
Mailing Address - Fax:
Practice Address - Street 1:1334 CAFFREY AVE APT 4J
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5130
Practice Address - Country:US
Practice Address - Phone:347-617-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist