Provider Demographics
NPI:1770714925
Name:SALEEBY, JENNY R (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:R
Last Name:SALEEBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 MILLS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8599
Mailing Address - Country:US
Mailing Address - Phone:803-985-3939
Mailing Address - Fax:803-985-3929
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4747
Practice Address - Fax:504-842-1242
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1344363AM0700X
LAPA.200601.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06083530Medicaid
LA2334191Medicaid
LA290678YH3UMedicare PIN