Provider Demographics
NPI:1669155917
Name:JONES, TANEEKA RENE
Entity type:Individual
Prefix:MS
First Name:TANEEKA
Middle Name:RENE
Last Name:JONES
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 1:2020 SEAGIRT BLVD APT 5D
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2842
Mailing Address - Country:US
Mailing Address - Phone:917-971-0668
Mailing Address - Fax:
Practice Address - Street 1:2020 SEAGIRT BLVD APT 5D
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2842
Practice Address - Country:US
Practice Address - Phone:917-971-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
NY1738702232252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency