Provider Demographics
NPI:1457596017
Name:DEJESUS, NEISHA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:NEISHA
Middle Name:ANN
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NEISHA
Other - Middle Name:ANN
Other - Last Name:HARIPRASHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1275 YORK AVENUE, BOX 124
Mailing Address - Street 2:MEMORIAL SLOAN KETTERING CANCER CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-639-5154
Mailing Address - Fax:212-717-3624
Practice Address - Street 1:1275 YORK AVENUE
Practice Address - Street 2:BOX 124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-342-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant