MEDICARE: MS. TESHIA SHARELL JOHNSON L.P.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	282407	NY

General Provider Information

NPI Number	:	1700124047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TESHIA SHARELL JOHNSON L.P.N

Provider Business Mailing Address
First Line	:	295 PARKRIDGE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1549
Country	:	US
Telephone Number	:	716-544-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 PARKRIDGE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1549
Country	:	US
Telephone Number	:	716-544-8117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	01/22/2013

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