Provider Demographics
NPI:1578832465
Name:SHEILA'S FITNESS JAM, LLC
Entity type:Organization
Organization Name:SHEILA'S FITNESS JAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TRAINER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMSON POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:ACSM CERTIFIED
Authorized Official - Phone:716-633-1833
Mailing Address - Street 1:378 HARRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-633-1833
Mailing Address - Fax:716-633-1833
Practice Address - Street 1:8965 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1419
Practice Address - Country:US
Practice Address - Phone:716-633-1833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY550748174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty