Provider Demographics
NPI:1568862050
Name:VALDES-MCKENZIE, JASMINE (MSED)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:VALDES-MCKENZIE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1518
Mailing Address - Country:US
Mailing Address - Phone:914-966-7900
Mailing Address - Fax:
Practice Address - Street 1:299 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1518
Practice Address - Country:US
Practice Address - Phone:914-966-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1746858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist