Provider Demographics
NPI:1649594276
Name:ALLEN, JIATTASHEY
Entity Type:Individual
Prefix:
First Name:JIATTASHEY
Middle Name:
Last Name:ALLEN
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 1:1303 HARROD AVE
Mailing Address - Street 2:#1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1303 HARROD AVE
Practice Address - Street 2:#1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-1605
Practice Address - Country:US
Practice Address - Phone:914-576-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606770163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse