Provider Demographics
NPI:1073323796
Name:STURDIVANT, JAZMIN KRYSTAL
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:KRYSTAL
Last Name:STURDIVANT
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 1:320 FELLER DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-1224
Mailing Address - Country:US
Mailing Address - Phone:631-835-3966
Mailing Address - Fax:
Practice Address - Street 1:320 FELLER DR
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-1224
Practice Address - Country:US
Practice Address - Phone:631-835-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula