Provider Demographics
NPI:1215314851
Name:SCHNELLER, JAIMIE A I
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:A
Last Name:SCHNELLER
Suffix:I
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 1:66 ALTMAR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1025
Mailing Address - Country:US
Mailing Address - Phone:631-525-7887
Mailing Address - Fax:
Practice Address - Street 1:66 ALTMAR AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1025
Practice Address - Country:US
Practice Address - Phone:631-525-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318648-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse