Provider Demographics
NPI:1124572177
Name:JONES, MISTY D
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:D
Last Name:JONES
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 1:110 LAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1558
Mailing Address - Country:US
Mailing Address - Phone:716-873-5159
Mailing Address - Fax:
Practice Address - Street 1:69 DELAWARE AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3812
Practice Address - Country:US
Practice Address - Phone:716-852-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579592172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker