Provider Demographics
NPI:1568789451
Name:JONES, SHAWNTAYE TAKISHA
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTAYE
Middle Name:TAKISHA
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 1:215 E WATERLOO RD STE 14
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1236
Mailing Address - Country:US
Mailing Address - Phone:330-634-3089
Mailing Address - Fax:234-542-2948
Practice Address - Street 1:215 E WATERLOO RD STE 14
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1236
Practice Address - Country:US
Practice Address - Phone:330-634-3089
Practice Address - Fax:234-542-2948
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
OH7711417251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker