Provider Demographics
NPI:1871843912
Name:WHALEY, ADRIENNE (MED)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:
Last Name:WHALEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 175TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2605
Mailing Address - Country:US
Mailing Address - Phone:718-658-3881
Mailing Address - Fax:
Practice Address - Street 1:10815 175TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2605
Practice Address - Country:US
Practice Address - Phone:718-658-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421909101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist