Provider Demographics
NPI:1770007247
Name:MOYA, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MOYA
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 1:341 ROUTE 322
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:14138-9608
Mailing Address - Country:US
Mailing Address - Phone:716-397-5634
Mailing Address - Fax:
Practice Address - Street 1:341 ROUTE 322
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-9608
Practice Address - Country:US
Practice Address - Phone:716-397-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse