Individual
JALICA ELLIBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5121 SWEET BAY ST APT 205, MASON, OH 45040-5981
(631) 375-5240
Mailing address
5121 SWEET BAY ST APT 205, MASON, OH 45040-5981
(631) 375-5240
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
04/11/2025
Last updated
04/11/2025
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