Provider Demographics
NPI:1376113092
Name:MURRAY, SHALIQUE TIFFANY (LICENSE NURSE)
Entity Type:Individual
Prefix:MS
First Name:SHALIQUE
Middle Name:TIFFANY
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LICENSE NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 JOHN MUIR DR STE 10095
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1144
Mailing Address - Country:US
Mailing Address - Phone:800-543-9399
Mailing Address - Fax:716-541-2738
Practice Address - Street 1:95 JOHN MUIR DR STE 10095
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1144
Practice Address - Country:US
Practice Address - Phone:800-543-9399
Practice Address - Fax:716-541-2738
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235736-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse