Provider Demographics
NPI:1255111068
Name:MUNN, DJUANA (NEW YORK LICENSED)
Entity type:Individual
Prefix:
First Name:DJUANA
Middle Name:
Last Name:MUNN
Suffix:
Gender:F
Credentials:NEW YORK LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4740
Mailing Address - Country:US
Mailing Address - Phone:716-803-3964
Mailing Address - Fax:
Practice Address - Street 1:1 N CAYUGA RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5407
Practice Address - Country:US
Practice Address - Phone:716-803-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEC-22-11134332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment