Provider Demographics
NPI:1962231084
Name:DA RE, JEANA THERESA (PHD, FACMG)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:THERESA
Last Name:DA RE
Suffix:
Gender:F
Credentials:PHD, FACMG
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1679
Mailing Address - Country:US
Mailing Address - Phone:716-984-9308
Mailing Address - Fax:
Practice Address - Street 1:1400 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5110
Practice Address - Country:US
Practice Address - Phone:716-984-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADRN-02251895207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics