Healthcare Provider Details

I. General information

NPI: 1184533812
Provider Name (Legal Business Name): JAMILYA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 BLAKE ST
BUFFALO NY
14211-1813
US

IV. Provider business mailing address

3224 WALDEN AVE APT 2
DEPEW NY
14043-2880
US

V. Phone/Fax

Practice location:
  • Phone: 716-570-5662
  • Fax:
Mailing address:
  • Phone: 716-570-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number349363-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: