Provider Demographics
NPI:1104438464
Name:AUDAIN, JAMILA
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:AUDAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMILA
Other - Middle Name:TANICE
Other - Last Name:MARCELLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11579 227TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1428
Mailing Address - Country:US
Mailing Address - Phone:631-805-6161
Mailing Address - Fax:
Practice Address - Street 1:11579 227TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1428
Practice Address - Country:US
Practice Address - Phone:631-805-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY749167-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty