Provider Demographics
NPI:1245643733
Name:FERNANDEZ, JOCELYN SHEILA GAJUDO (LPT)
Entity type:Individual
Prefix:
First Name:JOCELYN SHEILA
Middle Name:GAJUDO
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 WESTLAKE TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6534
Mailing Address - Country:US
Mailing Address - Phone:424-644-5061
Mailing Address - Fax:
Practice Address - Street 1:7401 WESTLAKE TER APT 808
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6529
Practice Address - Country:US
Practice Address - Phone:424-644-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist