Provider Demographics
NPI:1245701846
Name:HOSANNAH, JONNELLE (HAIR LOSS SPECILISTS)
Entity type:Individual
Prefix:MS
First Name:JONNELLE
Middle Name:
Last Name:HOSANNAH
Suffix:
Gender:F
Credentials:HAIR LOSS SPECILISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18730 KEESEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2332
Mailing Address - Country:US
Mailing Address - Phone:347-495-0702
Mailing Address - Fax:
Practice Address - Street 1:18730 KEESEVILLE AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2332
Practice Address - Country:US
Practice Address - Phone:347-495-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEC-17-007891744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management