Provider Demographics
NPI:1851942866
Name:WHELAN, JAYDE TAYLOR
Entity Type:Individual
Prefix:MRS
First Name:JAYDE
Middle Name:TAYLOR
Last Name:WHELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAYDE
Other - Middle Name:TAYLOR
Other - Last Name:RAGIMIERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 VAN HORN CIRCLE
Mailing Address - Street 2:APT D
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:631-284-7311
Mailing Address - Fax:845-897-3753
Practice Address - Street 1:1032 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3503
Practice Address - Country:US
Practice Address - Phone:845-897-3330
Practice Address - Fax:845-897-3753
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030251235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06579244Medicaid