Provider Demographics
NPI:1215614656
Name:JONES, ROISHAUNDA L
Entity type:Individual
Prefix:
First Name:ROISHAUNDA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNDA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:323 BERTHOUD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-2129
Mailing Address - Country:US
Mailing Address - Phone:916-807-8058
Mailing Address - Fax:
Practice Address - Street 1:323 BERTHOUD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-2129
Practice Address - Country:US
Practice Address - Phone:916-807-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker