Provider Demographics
NPI:1912272907
Name:SMITH, JAIYIDDAH MALIKAH (LPN)
Entity type:Individual
Prefix:MISS
First Name:JAIYIDDAH
Middle Name:MALIKAH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 SAMPSON AVE
Mailing Address - Street 2:3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2933
Mailing Address - Country:US
Mailing Address - Phone:917-520-4912
Mailing Address - Fax:
Practice Address - Street 1:2755 SAMPSON AVE
Practice Address - Street 2:3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2933
Practice Address - Country:US
Practice Address - Phone:917-520-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308810-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse