Provider Demographics
NPI:1831976000
Name:NEALE, HEATHER LYNN
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LYNN
Last Name:NEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:NEALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JESSIE SMILE'S, LLC
Mailing Address - Street 1:7464 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NY
Mailing Address - Zip Code:13402-9507
Mailing Address - Country:US
Mailing Address - Phone:315-750-8167
Mailing Address - Fax:
Practice Address - Street 1:7464 WATER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402-9507
Practice Address - Country:US
Practice Address - Phone:315-750-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00758341251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health