Provider Demographics
NPI:1922299635
Name:HERSEY, JEFFREY
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:HERSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 JEFFERSON AVE.
Mailing Address - Street 2:#202
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-817-9070
Mailing Address - Fax:650-817-9074
Practice Address - Street 1:541 JEFFERSON AVE
Practice Address - Street 2:#202
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1739
Practice Address - Country:US
Practice Address - Phone:650-817-9070
Practice Address - Fax:650-817-9074
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist