Provider Demographics
NPI:1326570813
Name:JT ALLEYNE ENTERPRISES, LLC
Entity type:Organization
Organization Name:JT ALLEYNE ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYNESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:757-453-5835
Mailing Address - Street 1:3575 BRIDGE RD
Mailing Address - Street 2:SUITE 8 #253
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1800
Mailing Address - Country:US
Mailing Address - Phone:757-366-5423
Mailing Address - Fax:
Practice Address - Street 1:5660 INDIAN RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5240
Practice Address - Country:US
Practice Address - Phone:757-366-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty