Individual
KHADIJATU JALLOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
(845) 521-1786
Mailing address
777 SEAVIEW AVE, STATEN ISLAND, NY 10305-3409
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
814412
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2997157
—
NY
Enumeration date
05/17/2021
Last updated
05/17/2021
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