Provider Demographics
NPI:1003359910
Name:MCLEAN, TELISHA
Entity Type:Individual
Prefix:
First Name:TELISHA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TELISHA
Other - Middle Name:
Other - Last Name:MCLEAN-SNIPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:912 E 224TH ST
Mailing Address - Street 2:#2F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4634
Mailing Address - Country:US
Mailing Address - Phone:646-319-7607
Mailing Address - Fax:
Practice Address - Street 1:912 E 224TH ST
Practice Address - Street 2:#2F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4634
Practice Address - Country:US
Practice Address - Phone:646-319-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse