Provider Demographics
NPI:1831168053
Name:JENKINS, MELINDA LEE (PHD, FNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 171ST ST
Mailing Address - Street 2:#54
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2803
Mailing Address - Country:US
Mailing Address - Phone:917-558-0345
Mailing Address - Fax:
Practice Address - Street 1:463 HAWTHORNE AVE
Practice Address - Street 2:LEAKE AND WATTS SERVICES, INC
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3441
Practice Address - Country:US
Practice Address - Phone:914-375-8756
Practice Address - Fax:914-375-8901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334010-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily