Provider Demographics
NPI:1306235437
Name:WHEELER, JAMIE (MSED)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 LOMBARDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4037
Mailing Address - Country:US
Mailing Address - Phone:631-459-7378
Mailing Address - Fax:
Practice Address - Street 1:1430 LOMBARDY BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4037
Practice Address - Country:US
Practice Address - Phone:631-459-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY962560371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist