Healthcare Provider Details

I. General information

NPI: 1962948505
Provider Name (Legal Business Name): JOCELYN'S BODY SCULPTING AND WELLNESS CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 DURHAM CT
BUFFALO NY
14204-1722
US

IV. Provider business mailing address

22 DURHAM CT
BUFFALO NY
14204-1722
US

V. Phone/Fax

Practice location:
  • Phone: 716-256-3601
  • Fax:
Mailing address:
  • Phone: 716-256-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberCI#343
License Number StateNY

VIII. Authorized Official

Name: MS. JOCELYN GUTHRIE
Title or Position: OWNER
Credential:
Phone: 716-256-3601