Provider Demographics
NPI:1841507381
Name:JALEIBA, SEDIAH (PTA,CLT)
Entity type:Individual
Prefix:MRS
First Name:SEDIAH
Middle Name:
Last Name:JALEIBA
Suffix:
Gender:F
Credentials:PTA,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 SLICE CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3184
Mailing Address - Country:US
Mailing Address - Phone:703-798-1599
Mailing Address - Fax:866-221-7925
Practice Address - Street 1:2813 SLICE CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3184
Practice Address - Country:US
Practice Address - Phone:703-798-1599
Practice Address - Fax:866-221-7925
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20455172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker