Provider Demographics
NPI:1346710308
Name:MYLES JONES, SHAUNELLA
Entity Type:Individual
Prefix:
First Name:SHAUNELLA
Middle Name:
Last Name:MYLES 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 1:625 DELAWARE AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1007
Mailing Address - Country:US
Mailing Address - Phone:716-884-6711
Mailing Address - Fax:716-884-0513
Practice Address - Street 1:625 DELAWARE AVE, SUITE 410
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1420
Practice Address - Country:US
Practice Address - Phone:716-884-6725
Practice Address - Fax:716-884-0513
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula