Provider Demographics
NPI:1679277412
Name:JENNINGS, MIKAELA JEAN (DO)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:JEAN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:JEAN
Other - Last Name:FLAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2692
Mailing Address - Country:US
Mailing Address - Phone:716-862-1881
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2692
Practice Address - Country:US
Practice Address - Phone:716-862-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program