Provider Demographics
NPI:1891220893
Name:JADOO, TANNIKA
Entity Type:Individual
Prefix:
First Name:TANNIKA
Middle Name:
Last Name:JADOO
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 1:10205 DAVENPORT CT
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3936
Mailing Address - Country:US
Mailing Address - Phone:718-696-8256
Mailing Address - Fax:
Practice Address - Street 1:10205 DAVENPORT CT
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3936
Practice Address - Country:US
Practice Address - Phone:718-696-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17Medicaid