Provider Demographics
NPI:1043082910
Name:SULLIVAN, TYESHA LASHON (BSN, RN)
Entity Type:Individual
Prefix:
First Name:TYESHA
Middle Name:LASHON
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10989 BLUFFSIDE DR APT 3203
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4406
Mailing Address - Country:US
Mailing Address - Phone:562-499-9659
Mailing Address - Fax:
Practice Address - Street 1:10989 BLUFFSIDE DR APT 3203
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4406
Practice Address - Country:US
Practice Address - Phone:562-499-9659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95246284163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult