Provider Demographics
NPI:1720866833
Name:BURKE-JAMES, KERONA SHELLIAN
Entity Type:Individual
Prefix:
First Name:KERONA
Middle Name:SHELLIAN
Last Name:BURKE-JAMES
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 1:3428 BRUNER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2667
Mailing Address - Country:US
Mailing Address - Phone:917-969-7561
Mailing Address - Fax:
Practice Address - Street 1:3428 BRUNER AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2667
Practice Address - Country:US
Practice Address - Phone:917-969-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30247490183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty