Provider Demographics
NPI:1144713124
Name:NEFF, JESSICA SARA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SARA
Last Name:NEFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SARA
Other - Last Name:HELMS/FLUSTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7107 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2746
Mailing Address - Country:US
Mailing Address - Phone:385-319-4928
Mailing Address - Fax:
Practice Address - Street 1:11150 EAST JEFFERSON
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:888-813-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055266OtherMEDICARE PIN
UT8760003008007Medicaid
UT260022408OtherRAILROAD MEDICARE