Provider Demographics
NPI:1659959773
Name:COLEY, JANELL M
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:M
Last Name:COLEY
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 1:125 SUNSET CENTER LN APT 404
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1153
Mailing Address - Country:US
Mailing Address - Phone:585-615-3654
Mailing Address - Fax:
Practice Address - Street 1:125 SUNSET CENTER LN APT 404
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1153
Practice Address - Country:US
Practice Address - Phone:585-615-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343549250514E251E00000X
NY13654374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health