Provider Demographics
NPI:1609698810
Name:UMMAN, JELYSSA MARY
Entity type:Individual
Prefix:
First Name:JELYSSA
Middle Name:MARY
Last Name:UMMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 N WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4322
Mailing Address - Country:US
Mailing Address - Phone:954-579-8510
Mailing Address - Fax:
Practice Address - Street 1:12730 N WINNERS CIR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4322
Practice Address - Country:US
Practice Address - Phone:954-579-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program