Wendy Shaw Jacoby

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

026281 Issued in CT

Practice address

9 Washington Ave
Hamden, CT 06518-3267

Phone

(203) 281-6678

Fax

(203) 281-3190

NPI assigned

Feb 19, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Connecticut Skinhealth LLP

  • Specialist
  • Shelton, CT
  • NPI 1649606385
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295879518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 WASHINGTON AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183267",
            "telephone_number": "203-281-6678",
            "fax_number": "203-281-3190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 WASHINGTON AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183267",
            "telephone_number": "203-281-6678",
            "fax_number": "203-281-3190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBY",
        "first_name": "WENDY",
        "middle_name": "SHAW",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "026281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Jackson
• Krystina Jackson
• Nayamka Jackson
• Suni Jacob, APRN
• Ayana Jacobs, LPN
• Amanda Lynn Jeffreys
• Sheila Jelley, PA
• Athena M. Jenkins, LCSW/RN
• Jennifer C Vessicchio, LCSW LLC
• Jeralyn R. Fantarella, DMD, P.C.

• Dermatology Physician in Hamden, CT
• Providers in Hamden, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.