Provider Demographics
NPI:1508488925
Name:JONES, TIFFANY KAIA
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:KAIA
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 1:23 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2216
Mailing Address - Country:US
Mailing Address - Phone:646-648-7304
Mailing Address - Fax:
Practice Address - Street 1:23 CHARLES ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2216
Practice Address - Country:US
Practice Address - Phone:646-648-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency