Provider Demographics
NPI:1376233809
Name:JONES, KIEALA SHAJUWANDA
Entity Type:Individual
Prefix:
First Name:KIEALA
Middle Name:SHAJUWANDA
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 1:6100 SHINGLEMAKER CT APT 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4853
Mailing Address - Country:US
Mailing Address - Phone:757-685-2122
Mailing Address - Fax:
Practice Address - Street 1:6100 SHINGLEMAKER CT APT 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4853
Practice Address - Country:US
Practice Address - Phone:757-235-7735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy