Provider Demographics
NPI:1043955156
Name:FEARON-ROBERTS, TASHA-GAYE NICOLA (RN)
Entity Type:Individual
Prefix:
First Name:TASHA-GAYE
Middle Name:NICOLA
Last Name:FEARON-ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E 34TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3801
Mailing Address - Country:US
Mailing Address - Phone:929-319-6529
Mailing Address - Fax:
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:347-621-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY775093-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse