Individual
SHALET M JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 ROUTE 130 S, CINNAMINSON, NJ 08077-2845
(609) 310-9412
Mailing address
17 RIDGEWOOD PL, WILLINGBORO, NJ 08046-2515
(609) 310-9412
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QS1000X
Student Health Clinic/Center
—
—
Other
Enumeration date
12/10/2019
Last updated
12/11/2019
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