Provider Demographics
NPI:1053786517
Name:JARRETT-MCLEOD, SHIRNETTE NADINE (06/25/1974)
Entity type:Individual
Prefix:
First Name:SHIRNETTE
Middle Name:NADINE
Last Name:JARRETT-MCLEOD
Suffix:
Gender:F
Credentials:06/25/1974
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PROSPECT AVE
Mailing Address - Street 2:APT. 2G
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1044
Mailing Address - Country:US
Mailing Address - Phone:646-255-0042
Mailing Address - Fax:
Practice Address - Street 1:300 E PROSPECT AVE
Practice Address - Street 2:APT. 2G
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1044
Practice Address - Country:US
Practice Address - Phone:646-255-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320897164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse