Provider Demographics
NPI:1124870191
Name:COFAN, JAHSHELA
Entity type:Individual
Prefix:
First Name:JAHSHELA
Middle Name:
Last Name:COFAN
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 1:2810 JACKSON AVE APT PH3B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3092
Mailing Address - Country:US
Mailing Address - Phone:917-553-6302
Mailing Address - Fax:
Practice Address - Street 1:2810 JACKSON AVE APT PH3B
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3092
Practice Address - Country:US
Practice Address - Phone:917-553-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator