Healthcare Provider Details

I. General information

NPI: 1639034028
Provider Name (Legal Business Name): KEESHA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CASTLE PL
BUFFALO NY
14214-2502
US

IV. Provider business mailing address

50 CASTLE PL
BUFFALO NY
14214-2502
US

V. Phone/Fax

Practice location:
  • Phone: 716-846-3266
  • Fax:
Mailing address:
  • Phone: 716-846-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: