Provider Demographics
NPI:1861948531
Name:PRYOR, JASMINE NICOLE (MSED)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LAFAYETTE RD
Mailing Address - Street 2:APT 524
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2929
Mailing Address - Country:US
Mailing Address - Phone:315-870-2994
Mailing Address - Fax:315-698-0033
Practice Address - Street 1:5962 ROUTE 31
Practice Address - Street 2:BOX 10 SUITE 7
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-698-0033
Practice Address - Fax:315-698-0031
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency