Provider Demographics
NPI:1780991026
Name:WAKINS, JAYSHREE DANIELLE
Entity type:Individual
Prefix:
First Name:JAYSHREE
Middle Name:DANIELLE
Last Name:WAKINS
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 1:400 S EL CIELO RD STE EF
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7926
Mailing Address - Country:US
Mailing Address - Phone:760-416-1753
Mailing Address - Fax:760-416-0263
Practice Address - Street 1:400 S EL CIELO RD STE EF
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7926
Practice Address - Country:US
Practice Address - Phone:760-416-1753
Practice Address - Fax:760-416-0263
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner