Provider Demographics
NPI:1306109970
Name:WHITLEY, JATAON SELENE (MS)
Entity type:Individual
Prefix:
First Name:JATAON
Middle Name:SELENE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W MOSHOLU PKWY S APT 18L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1143
Mailing Address - Country:US
Mailing Address - Phone:347-278-3747
Mailing Address - Fax:
Practice Address - Street 1:40 W MOSHOLU PKWY S APT 18L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1143
Practice Address - Country:US
Practice Address - Phone:347-278-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist