Provider Demographics
NPI:1114712320
Name:JILES, SYIEDAH
Entity type:Individual
Prefix:
First Name:SYIEDAH
Middle Name:
Last Name:JILES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 VAUXHALL RD
Mailing Address - Street 2:SUITE 7 #1084
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088
Mailing Address - Country:US
Mailing Address - Phone:908-244-1338
Mailing Address - Fax:
Practice Address - Street 1:30 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2919
Practice Address - Country:US
Practice Address - Phone:862-438-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ347C00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle