Basic Information
| Provider Information | |||||||||
| NPI: | 1518219518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZCZESNY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | DC, CNIM | ||||||||
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| OtherLastName: | FENDER | ||||||||
| OtherFirstName: | JESSICA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8749 ASHWORTH DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046732857 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2150 TOWN SQUARE PL | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817686730 | ||||||||
| FaxNumber: | 2817686766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2012 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic | 246ZE0600X | 246ZE0600X | FL | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.