=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194472944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHALAYA DANYELLE FERRELL LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2022
-----------------------------------------------------
Last Update Date | 03/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1796 CLINTON ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14206-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-826-1661
-----------------------------------------------------
Fax | 716-826-6110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1796 CLINTON ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14206-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-826-1661
-----------------------------------------------------
Fax | 716-826-6110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 028469-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------