Jaquela Danielle Blyther-Tyme

Primary specialty

Social WorkerTaxonomy code 104100000X

License

115152 Issued in NY

Practice address

191 E Marshall St
Hempstead, NY 11550-7421

Phone

(516) 439-2036

NPI assigned

Jul 13, 2022

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

Other names 1

• Mrs. Jaquela Danielle Blyther Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1497489694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 E MARSHALL ST",
            "city": "HEMPSTEAD",
            "state": "NY",
            "postal_code": "115507421",
            "telephone_number": "516-439-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 E MARSHALL ST",
            "city": "HEMPSTEAD",
            "state": "NY",
            "postal_code": "115507421",
            "telephone_number": "516-439-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYTHER-TYME",
        "first_name": "JAQUELA",
        "middle_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "115152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAQUELA",
            "last_name": "BLYTHER",
            "middle_name": "DANIELLE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Social Worker in Hempstead, NY
• Providers in Hempstead, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.