Provider Demographics
NPI:1205262524
Name:JIMENEZ, DEHISY L
Entity type:Individual
Prefix:MS
First Name:DEHISY
Middle Name:L
Last Name:JIMENEZ
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 1:200 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2106
Mailing Address - Country:US
Mailing Address - Phone:914-737-1591
Mailing Address - Fax:914-734-1638
Practice Address - Street 1:200 DECATUR AVENUE - C/O WJCS
Practice Address - Street 2:OAKSIDE ELEMENTARY SCHOOL
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-737-1591
Practice Address - Fax:914-734-1638
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program