Provider Demographics
NPI:1992488076
Name:SCHILDT, JESSICA TAYLOR (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:TAYLOR
Last Name:SCHILDT
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 1:17 ASTOR DR
Mailing Address - Street 2:
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1035
Mailing Address - Country:US
Mailing Address - Phone:631-574-7785
Mailing Address - Fax:
Practice Address - Street 1:17 ASTOR DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1035
Practice Address - Country:US
Practice Address - Phone:631-574-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse