Provider Demographics
NPI:1194472944
Name:FERRELL, SHALAYA DANYELLE (LMT)
Entity Type:Individual
Prefix:
First Name:SHALAYA
Middle Name:DANYELLE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHALAYA
Other - Middle Name:DANYELLE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1796 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-3126
Mailing Address - Country:US
Mailing Address - Phone:716-826-1661
Mailing Address - Fax:716-826-6110
Practice Address - Street 1:1796 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-3126
Practice Address - Country:US
Practice Address - Phone:716-826-1661
Practice Address - Fax:716-826-6110
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028469-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028469-01OtherLICENSE