Provider Demographics
NPI:1063097012
Name:SHOWERS, DONYALE JONES
Entity type:Individual
Prefix:
First Name:DONYALE
Middle Name:JONES
Last Name:SHOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CHARTER OAK CT
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2790
Mailing Address - Country:US
Mailing Address - Phone:609-545-2300
Mailing Address - Fax:609-545-2385
Practice Address - Street 1:500 RAVENS RD APT 315
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1439
Practice Address - Country:US
Practice Address - Phone:609-545-2300
Practice Address - Fax:609-545-2385
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0658430Medicaid