Provider Demographics
NPI:1831397736
Name:REID, JAHIDAH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:JAHIDAH
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:19705C 65TH CRES
Mailing Address - Street 2:APT. 1C
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3965
Mailing Address - Country:US
Mailing Address - Phone:718-264-2533
Mailing Address - Fax:
Practice Address - Street 1:19705C 65TH CRES
Practice Address - Street 2:APT. 1C
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3965
Practice Address - Country:US
Practice Address - Phone:718-264-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0111421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant