Provider Demographics
NPI:1427827294
Name:DILLARD, LAKESHA
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:
Last Name:DILLARD
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:PO BOX 3261
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3261
Mailing Address - Country:US
Mailing Address - Phone:716-982-6199
Mailing Address - Fax:716-657-3227
Practice Address - Street 1:30 HOWARD ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-1514
Practice Address - Country:US
Practice Address - Phone:716-982-6199
Practice Address - Fax:716-657-3227
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639639163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice